The impact of the COVID-19 pandemic on diagnosis and treatment of patients with soft tissue and bone sarcomas or aggressive benign musculoskeletal diseases: A single-center retrospective study (SarCorD study)

Abstract

BackgroundThe COVID-19 pandemic led to a rapid reorganization of healthcare activities, leading to reduced access to clinics, interruption of screenings, and treatment schedule modifications in several cancer types. Few data are available on sarcomas. We analyzed COVID-19-related diagnostic delay in a sarcoma referral center in Italy.MethodsWe retrospectively enrolled in this study patients with histological diagnosis of soft tissue or bone sarcoma and aggressive benign musculoskeletal diseases obtained during the first year of the pandemic (Covid group) or the year before (Control group) and followed at the Regina Elena National Cancer Institute in Rome. The primary endpoint was the time from the first symptom to histological diagnosis.ResultsWe evaluated 372 patients, 185 of whom were eligible for primary endpoint analysis (92 patients in the Control group and 93 patients in the Covid group). The patients were affected by soft tissue sarcoma in most cases (63.0% and 66.7% in Covid and Control groups, respectively). We observed a diagnostic delay in the Covid group with a median time from the first symptom to the definitive histological diagnosis of 103.00 days (95% CI 92.77–113.23) vs. 90.00 days (95% CI 69.49–110.51) in the Control group (p = 0.024), but not a delay in treatment beginning (151 days, 95% CI 132.9–169.1 vs. 144 days, 95% CI 120.3–167.7, respectively, p = 0.208). No differences in stage at diagnosis were observed (12% vs. 16.5% of patients with metastatic disease at diagnosis in the Covid and Control groups, respectively, p = 0.380). Progression-free survival (p = 0.897) and overall survival (p = 0.725) were comparable in the subgroup of patients affected by soft tissue sarcoma.ConclusionsA delay in sarcoma diagnosis but not in starting treatment has been observed during the first year of the COVID-19 pandemic. Nevertheless, no difference in stage at diagnosis or in terms of survival has been observed.

The impact of curfews on emergency departments and orthopedic traumas

“…[ 16 ] Onesti et al observed a diagnostic delay in soft tissue or bone sarcomas with a median time from the first symptom to the definitive histological diagnosis. [ 17 ]…”

Impact of the coronavirus disease 2019 pandemic on sarcoma management in France: a 2019 and 2020 comparison

“…9 In a single-center study conducted in Rome, our Italian colleagues revealed, in a cohort of 372 patients, a significant increase in the time of diagnosis (from 90 to 103 days) without a significant increase in the time to treatment (from 144 to 151 days). 10 Lastly, an international multicenter study stressed that stringent lockdown was associated with a major decrease in cancer surgeries such as sarcoma surgery (413 newly diagnosed sarcoma, odds ratio 0.67 (95% CI: .59–0.67) for non-surgical management during stringent lockdown). 11 In France, during the first pandemic year, there were two stringent lockdowns (17 March–11 May 2020 and 30 October–15 December).…”

Telemedicine in Care of Sarcoma Patients beyond the COVID-19 Pandemic: Challenges and Opportunities

“…Another retrospective study including a larger sample of 372 patients with bone sarcomas and soft tissue sarcomas (STS) confirmed this delay until a definitive histologic diagnosis before and after the pandemic (90 versus 103 days, respectively, p-value: 0.024). However, no statistically significant differences were observed in terms of the stage at diagnosis, progression-free survival (PFS) and overall survival (OS) between the COVID-19 arm and the control arm [28].…”

“…However, regarding the implementation of telehealth in psychological support, there are certain problems needed to be addressed, pertaining to the unique characteristics of ma-lignancies under therapy [76]. For example, sarcomas as unique entities require a more detailed approach that is tailored to the patient's individualized needs [28].…”