The impact of early‐stage COVID‐19 pandemic on the diagnosis and treatment of gastric cancer: A cross‐sectional study using a large‐scale cancer registry in Hiroshima, Japan

Abstract

Background After the confirmation of coronavirus infection in Japan, a behavioral change caused people and physicians to refrain from visiting hospitals or undergoing examinations. This study aimed to assess how the trend of diagnosis in gastric cancers changed, and how it affected the therapeutic strategies and the interval from diagnosis to treatment during the COVID‐19 pandemic. Methods We use 15 cancer‐designated hospitals’ registries in Hiroshima, Japan. The target period was March to December 2020, and the same period in 2019 was set as the control period. The monthly mean of diagnoses and the interval from diagnosis to treatment were compared overall and separately by age, treatment procedure, diagnostic process, and clinical stage. Result In 2020, the monthly mean (standard deviation [SD]) of patients was 192.2 (29.9), a significant 20.1% decrease from 240.7 (20.7) in 2019 due to older age and curative treatment groups. By reason for performing endoscopy, the change rate in cancer screening, endoscopic follow‐up, and symptomatic status were ‐27.0%, ‐18.0%, and ‐17.3%, respectively. Meanwhile, the interval (days) from diagnosis to treatment (SD) was 37.8 (26.5) in 2020, significantly shorter than 46 (31.5) in 2019. Conclusion From 2019 to 2020, we observed a significant decrease in the diagnosis of curable early‐stage gastric cancer and treatments, although the interval from diagnosis to treatment decreased. This study suggests that cancer screening played a significant role in the decline in cancer diagnosis that occurred during the COVID‐19 pandemic. Even under COVID‐19 pandemic conditions, there should be an awareness of cancer screening and endoscopic follow‐up.

Impact of the COVID‐19 pandemic on the mortality among patients with colorectal cancer in Hiroshima, Japan: A large cancer registry study

“…This is likely to be due to factors such as a decrease in the overall number of hospital visits following the start of the COVID-19 pandemic and a decrease in the waiting time before surgery. 11,25 The number of beds in the acute care wards occupied by patients with COVID-19 remained below 5%. 26 Regarding the changes in treatment options, there was a decrease in open surgery and an increase in laparoscopic surgery during the pandemic period, which might be due to the results of a randomized control trial in Japan reported in 2016, showing non-inferiority of laparoscopic surgery to open surgery.…”

“…Contrary to what might be assumed, the interval from diagnosis to laparoscopic surgery and chemotherapy was shorter during the COVID‐19 pandemic period, unlike that in previous studies. This is likely to be due to factors such as a decrease in the overall number of hospital visits following the start of the COVID‐19 pandemic and a decrease in the waiting time before surgery 11,25 . The number of beds in the acute care wards occupied by patients with COVID‐19 remained below 5% 26 .…”

“…However, during first wave of COVID‐19 (March to May 2020), the number of colorectal cancer screening decreased 50% than that of before pandemic 8 . As in other Organization for Economic Cooperation and Development countries, the number of upper and lower gastrointestinal endoscopies performed in medical institutions in Japan decreased by 30%–100% during the COVID‐19 epidemic compared with those in previous years 3,9–11 …”

“…8 As in other Organization for Economic Cooperation and Development countries, the number of upper and lower gastrointestinal endoscopies performed in medical institutions in Japan decreased by 30%-100% during the COVID-19 epidemic compared with those in previous years. 3,[9][10][11] In addition, cancer care and treatment changed, with treatment algorithms that differed from standard practice. 12,13 Delays in the time to starting chemotherapy and radiation therapy also occurred.…”

Impact of COVID-19 on Gynecological Cancer Incidence: A Large Cohort Study in Japan

“…However, there is no trajectory of an increase in advanced rectal cancer cases [10]. Kodama et al also reported that even under COVID-19 pandemic, if we should be an awareness of cancer screening and endoscopic follow-up, cancer screening played a signi cant role in the decline in cancer diagnosis [11]. However, as with gynecological cancers, the number of cases may increase after 2021, and caution should be exercised for us.…”