Stage shift and relative survival for head and neck cancer during the 2020 COVID-19 pandemic: a population-based study of temporal trends

Peacock, Hanna M.; De Gendt, Cindy; Silversmit, Geert; Nuyts, Sandra; Casselman, Jan; Machiels, Jean-Pascal; Giusti, Francesco; van Gool, Bart; Vander Poorten, Vincent; Van Eycken, Liesbet

doi:10.3389/fonc.2023.1253968

Cited by 6 publications

(2 citation statements)

References 26 publications

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“…In 2020 this cohort demonstrated a decreased survival in comparison to the pre-pandemic period. Similar results were cited by Peacok et al [ 43 ]. As for 2021, there was a 20% increase in survival in comparison to 2019, but such significant difference may be due to a shorter follow-up in comparison to those patients from 2019, and perhaps such difference will balance after a 5-year follow-up.…”

Section: Discussionsupporting

confidence: 92%

Impact of COVID-19 pandemic among patients with lung and head and neck cancer assisted in a public cancer center in Brazil

Viana Veloso,

Amaral,

Nogueira-Rodrigues

2024

BMC Cancer

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Background There is no updated national data regarding the real impact of the COVID-19 pandemic on delaying diagnosis and treatment among patients with lung, and head, and neck cancers in Brazil. This study aimed to analyze the COVID-19 pandemic impact on cancer diagnosis and clinical outcomes among lung, head, and neck cancer patients assisted in a tertiary cancer center in Southeastern Brazil, as well as to analyze these patients’ pretreatment clinical features. Methods Retrospective cohort of patients with lung or head and neck cancer assisted in a tertiary cancer center in southeastern Brazil between January/2019 and December/2021. To assess statistical differences among groups [i.e., cohort 2019 versus (vs.) 2020 and 2019 vs. 2021] chi-square test was used with a 5% significance level and 90% power for sample size calculation. Differences among baseline clinical features and sociodemographic characteristics were evaluated either by T-test for two samples or Fisher’s or Pearson’s chi-square test (for quantitative or qualitative variables). All utilized tests had a 5% significance level. Results Six hundred fifty-two patients were included, 332 with lung and 320 with head and neck cancer; it was observed a significant decrease in oncologic treatment recommendations and increase in palliative care recommendation for patients with lung cancer, despite similar stages at diagnosis. During the COVID-19 pandemic, more pain symptoms were reported at the first Oncology assessment for patients with head and neck cancer (p < 0.05). Compared to 2019, head and neck cancer patients diagnosed in 2021 presented a worse initial performance status (p = 0.008). There was a statistically significant increase in survival for patients diagnosed with head and neck cancer in 2021 when compared to 2019 (p = 0.003). Conclusions This research highlights low survival rates for patients with lung and head and neck cancer in Brazil, even before the pandemic started, as consequence of advanced diseases at diagnosis at the public health system and clinical degrading features. Additionally, there was an increase incidence in both lung cancer and head and neck cancer despite no differences in clinical stage. This reflects how fragile is the public healthcare system even before facing an acute public health crisis such as the COVID-19 pandemic. Yet, the total impact on public health may follow for many years.

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Section: Discussionsupporting

confidence: 92%

Impact of COVID-19 pandemic among patients with lung and head and neck cancer assisted in a public cancer center in Brazil

Viana Veloso,

Amaral,

Nogueira-Rodrigues

2024

BMC Cancer

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“…Based on their changes in incidence and clinical stage, the 11 investigated tumour types were divided in four groups (Figure 1B): cancers with general decline in incidence and stage shift were cervical, prostate, colorectal, bladder and breast cancer; cancers with general decline in incidence but without stage shift were head and neck cancers; a cancer without general decline in incidence but with excess stage shifts was ovarian and fallopian tube cancer; and cancers with neither decline in incidence nor excess stage shifts were pancreatic, endometrial, lung and kidney cancer. Findings for stage at diagnosis for colorectal (submitted), breast (submitted) and head and neck cancer 29 have been assessed in-depth in separate articles.…”

Section: Changes In Cancer Incidence and Stagementioning

confidence: 99%

Cancer incidence, stage shift and survival during the 2020 COVID‐19 pandemic: A population‐based study in Belgium

Peacock,

Van Meensel,

Van Gool

et al. 2024

Intl Journal of Cancer

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The COVID‐19 pandemic was associated with a profound decline in cancer diagnoses in 2020 in Belgium. Disruption in diagnostic and screening services and patient reluctance to visit health facilities led to fewer new cases and concerns that cancers may be diagnosed at more advanced stages and hence have poorer prognosis. Using data from mandatory cancer registration covering all of Belgium, we predicted cancer incidence, stage distribution and 1‐year relative survival for 2020 using a Poisson count model over the preceding years, extrapolated to 2020 for 11 common cancer types. We compared these expected values to the observed values in 2020 to specifically quantify the impact of the COVID‐19 pandemic, accounting for background trends. A significantly lower incidence was observed for cervical, prostate, head and neck, colorectal, bladder and breast cancer, with limited or no recovery of diagnoses in the second half of 2020 for these cancer types. Changes in stage distribution were observed for cervical, prostate, bladder and ovarian and fallopian tube tumours. Generally, changes in stage distribution mainly represented decline in early‐stage than in late‐stage tumours. One‐year relative survival was lower than predicted for lung cancer and colorectal cancer. Stage shifts are hypothesised to result from alterations in access to diagnosis, potentially due to prioritisation of symptomatic patients, and patient reluctance to contact a physician. Since there were over 5000 fewer cancer diagnoses than expected by the end of 2020, it is critical to monitor incidence, stage distribution and survival for these cancers in the coming years.

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Negative excess oral and pharyngeal cancer mortality in Europe during the early pandemic years

Petti

2024

Oral Diseases

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ObjectiveThe COVID‐19 pandemic had direct and indirect effects on oral and pharyngeal cancer (OPC) mortality due to high COVID‐19 mortality risk among cancer patients, and to the COVID‐19 response that caused treatment delays and reduced routine visits. This study investigated the excess OPC mortality in Europe during the early pandemic years.MethodsMortality and population data were gathered from the Eurostat database. The 2011–2019 mortality rates were used to estimate the 2020–2021 expected rates through joinpoint trend analysis. The excess mortality rates (observed minus expected mortality) with 95% confidence intervals (95 CIs) were assessed.ResultsStatistically significant negative excess age‐standardized and crude (age strata <65 and ≥65 years) OPC mortality rates in males and females, in the European Union (EU, 27 countries) and Europe were reported. The estimated OPC missing deaths in EU were 831 (95 CI, 630–985) and 1240 (95 CI, 1039–1394) in 2020 and 2021, respectively, with differences between sexes, age strata, and countries. The OPC deaths in the EU and Europe were 3.6% and 3.5% lower than expected.ConclusionMissing OPC deaths reported in Europe in 2020–2021 could be explained by changes in death certification of OPC patients who developed COVID‐19, rather than a real OPC mortality decline.

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Stage shift and relative survival for head and neck cancer during the 2020 COVID-19 pandemic: a population-based study of temporal trends

Cited by 6 publications

References 26 publications

Impact of COVID-19 pandemic among patients with lung and head and neck cancer assisted in a public cancer center in Brazil

Impact of COVID-19 pandemic among patients with lung and head and neck cancer assisted in a public cancer center in Brazil

Cancer incidence, stage shift and survival during the 2020 COVID‐19 pandemic: A population‐based study in Belgium

Negative excess oral and pharyngeal cancer mortality in Europe during the early pandemic years

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