The COVID-19 Pandemic Is Associated with Reduced Survival after Pancreatic Ductal Adenocarcinoma Diagnosis: A Single-Centre Retrospective Analysis

Abstract

The COVID-19 pandemic has hugely disrupted healthcare provision, including oncology services. To evaluate the effects of the pandemic on referral routes leading to diagnosis, treatments, and prognosis in patients with pancreatic ductal adenocarcinoma, we performed a retrospective cohort study at a single tertiary centre in the UK. The patients were identified from the weekly hepatopancreatobiliary multidisciplinary team meetings between February 2018 and March 2021. The demographic, referral, and treatment data for each patient and date of death, where applicable, were extracted from the electronic patient record. The patients (n = 203) were divided into “pre-pandemic” and “pandemic” cohorts based on a referral date cut-off of 23rd March 2020. The median survival was 7.4 months [4.9–9.3] in the “pre-pandemic” cohort (n = 125), halving to 3.3 months [2.2–6.0], (p = 0.015) in the “pandemic” cohort (n = 78). There was no significant difference in patient characteristics between the two cohorts. There was a trend toward increased emergency presentations at diagnosis and reduced use of surgical resection in the “pandemic” cohort. This small-scale study suggested that the COVID-19 pandemic is associated with a halving of median survival in pancreatic ductal adenocarcinoma. Urgent further studies are required to confirm these findings and examine corresponding effects in other cancer types.

Reduced Pancreatic Cancer Survival During COVID-19 Pandemic

“…In real terms, this represented a 4-month reduction in median survival. 3 Our findings are validated by a North American study, which found an increased proportion of patients presenting at later stages and a reduction of 2 months in overall survival in those diagnosed with metastatic PDAC during the pandemic compared with before the pandemic. 4 Several other studies have demonstrated the negative effects of COVID-19 on PDAC diagnosis and management.…”

“…We recently published results from our British single-center study, suggesting a halving of median survival for PDAC patients diagnosed during the pandemic compared to a comparable pre-pandemic cohort. In real terms, this represented a 4-month reduction in median survival 3. Our findings are validated by a North American study, which found an increased proportion of patients presenting at later stages and a reduction of 2 months in overall survival in those diagnosed with metastatic PDAC during the pandemic compared with before the pandemic 4…”

“…Therefore, any delays in diagnosis risk restriction of treatment options and a reduction in overall survival. 3,4 This is supported by the evidence showing that referral pathways and treatment regimens have changed during the pandemic. [3][4][5][6][7] The results of the studies to date suggesting the substantial impact of the COVID-19 pandemic on PDAC are very concerning.…”

“…While larger datasets would be valuable in fully evaluating any effect, in our study we did not identify a significant proportion of deaths from COVID-19 in the "pandemic" cohort and found the overall reduction in survival was unaffected after exclusion of the small number of cases. 3 Two-week wait referrals in England for upper-gastrointestinal malignancies from primary care fell by 65 percent compared with 2019 during the pandemic, inevitably leading to delays in diagnosis and treatment. 8 PDAC often presents indolently with vague symptoms and any reduction in primary care contact could shift diagnosis to a later stage of disease.…”

The impact of Omicron pandemic and COVID‐19 vaccination on the pancreatic adenocarcinoma patients

“…However, continuous follow-ups should be processed to further observe in a long term. Some studies proposed that the COVID-19 could impair the prognoses of pancreatic cancer patients, 21,22 which probably resulted from the impaired cancer screening, diagnosis, and care. 23 The vaccination was not discovered associated with the OS of PAC patients.…”