The Impact of the COVID-19 Pandemic on Hepatocellular Carcinoma Time to Treatment Initiation: A National Cancer Database Study

Abstract

Background The COVID-19 pandemic strained oncologic care access and delivery, yet little is known about how it impacted hepatocellular carcinoma (HCC) management. Our study sought to evaluate the annual effect of the COVID-19 pandemic on time to treatment initiation (TTI) for HCC. Methods The National Cancer Database was queried for patients diagnosed with clinical stages I–IV HCC (2017–2020). Patients were categorized based on their year of diagnosis as “Pre-COVID” (2017–2019) and “COVID” (2020). TTI based on stage and type of treatment first received was compared by the Mann-Whitney U test. A logistic regression model was used to evaluate factors of increased TTI and treatment delay (> 90 days). Results In total, 18,673 patients were diagnosed during Pre-COVID, whereas 5249 were diagnosed during COVID. Median TTI for any first-line treatment modality was slightly shorter during the COVID year compared with Pre-COVID (49 vs. 51 days; p < 0.0001), notably in time to ablation (52 vs. 55 days; p = 0.0238), systemic therapy (42 vs. 47 days; p < 0.0001), and radiation (60 vs. 62 days; p = 0.0177), but not surgery (41 vs. 41 days; p = 0.6887). In a multivariate analysis, patients of Black race, Hispanic ethnicity, and uninsured/Medicaid/Other Government insurance status were associated with increased TTI by factors of 1.057 (95% CI: 1.022–1.093; p = 0.0013), 1.045 (95% CI: 1.010–1.081; p = 0.0104), and 1.088 (95% CI: 1.053–1.123; p < 0.0001), respectively. Similarly, these patient populations were associated with delayed treatment times. Conclusions For patients diagnosed during COVID, TTI for HCC, while statistically significant, had no clinically significant differences. However, vulnerable patients were more likely to have increased TTI.

The Impact of the COVID-19 Pandemic on Time to Treatment in Surgical Oncology: A National Registry Study in The Netherlands

“…Notably, the largest reduction was seen in bladder cancer care with a reduction of 6 days from diagnosis to radical cystectomy [23]. In contrast, two population-based HPB studies in The Netherlands and the United States found no reduction in time to treatment initiation [26,27]. In our cohort, the faster time to start of treatment for oncological patients during the pandemic is probably the result of the prioritization of oncological care in The Netherlands.…”

Imaging Delay Following Liver-Directed Therapy Increases Progression Risk in Early- to Intermediate-Stage Hepatocellular Carcinoma

“…There were also no significant differences in race between patients being evaluated for transplant versus those on a non-transplant treatment track. Additionally, it is well established that health insurance status is another barrier to receiving a liver transplant; particularly, patients without insurance or with Medicaid coverage have both delayed treatment and lower rates of treatment [ 28 , 29 ]. This patient population also exhibits a higher risk of death [ 29 , 30 ].…”

The COVID-19 pandemic and clinical characteristics of colorectal cancer: a multicenter retrospective study

“…Apart from the direct effect of the viral infection, the rapid increase in patients with COVID-19 under limited resources has led to several governments and hospitals prioritizing management of patients and to delays in diagnosis and treatment of other diseases [7][8][9]. The severity of urgent diseases, regardless of COVID-19 infection, increased, with worse clinical outcomes during the COVID-19 pandemic relative to the severity in the prepandemic period [10][11][12], Moreover, the priority for treating malignancy was adjusted during the COVID-19 era as suggested by the World Health Organization that recommended postponement of nonurgent procedures, although malignancy is a life-threatening condition that may progress into an emergency situation [8].…”