A Spanish overview study, presented in a press release during the World Conference of the International Association for the Study of Lung Cancer (WCLC), found that coronavirus 2019 (COVID-19) has been affected greatly affect the diagnosis and prognosis of patients with lung cancer.
The study found that 38% fewer new lung cancer cases were diagnosed during COVID-19 compared to pre-COVID-19, with more symbolic and more severe cases of NSCLC being detected during the pandemic period .
“Lung cancer studies were affected during COVID-19 with as little as 38% of new cases in non-small cell lung cancer, more symbolic and more severe cases have been confirmed, but not in small cell lung cancer , ”Said Roxana Reyes, MD.
In Spain, when a state of emergency was imposed as a result of the pandemic, it prioritized health care services to patients with COVID-19, also many people were also circulating and delaying physician examinations, leading to major changes in cancer management. and initial cancer studies, recommended Reyes, from the Thoracic Oncology Group at the Clinic Hospital of Barcelona. Therefore, delays in cancer treatment and studies were observed that were associated with higher mortality rates.
The researchers collected clinical and biological data from 2 tertiary hospitals in Spain of new cases of non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) over 2 periods: January to June 2019 (before COVID-19) and January to June 2020 (during COVID-19). The main end point of the study was the differences between the two periods in terms of the number of new lung cancer cases and the severity of the disease, which was characterized by performance status, stage, and major complications. at any time of adjudication. The secondary endpoint was the 30-day mortality rate by time and histology group.
A total of 162 patients with newly diagnosed lung cancer were enrolled in the study, including 100 pre-diagnosed COVID-19 and 62 during COVID-19. A 38% reduction in diagnoses was seen between the two periods.
Of these patients, 68% had NSCLC and 32% had SCLC. The median age was around 66 years and the majority were male (70%) with advanced disease (54%).
Most of the baseline characteristics were similar between the pre-COVID-19 and pre-COVID-19 patients, with the exception of smoking status. In the newly diagnosed pre-COVID-19 patients, 27% were current smokers, 65% were smokers, and 8% were non-smokers, but the rates 42%, 42%, and 16%, respectively, during the -COVID-19 Group period.
In the NSCLC population in particular (n = 110), there was a 36% reduction in new studies during COVID-19 and more severe cases were confirmed during COVID-19. The rate of advanced disease diagnosed was 46% in 2019 compared to 58% in 2020, and the incidence of symptomatic disease was 63% versus 74% for before and during COVID-19, respectively. More than 2 metastatic sites were observed at baseline in 16% of those diagnosed during COVID-19 versus in 12% diagnosed before COVID-19. Oncology crisis was reported in 7% diagnosed in 2020 versus 3% diagnosed in 2019. In addition, 44% of hospitalized deaths were reported in patients diagnosed during COVID -19 compared with 17% in those tested during COVID-19.
For SCLC, 33 cases were pre-COVID-19 and 19 were tested during COVID-19, resulting in a 42% reduction in new diagnoses. Worse disease, however, was not seen in 2020 cases. The rate of advanced disease was 67% in those diagnosed in 2019 versus 52% among those diagnosed in 2020 and symbolic disease was reported in 79% versus 74%, respectively. More than 2 metastatic sites at baseline were diagnosed in 36% in 2019 compared to 26% in 2020. Oncology crisis was reported in 12% before COVID-19 and 5% during COVID-19. The rate of hospitalization (33% vs. 21%) and hospital death (18% vs. 0%) were lower in the pre-COVID-19 group compared with the pre-COVID-19 group, respectively.
During the month, new cases of SCLC diagnosis fell entirely from January to June in 2020 but increased again in July but new cases of NSCLC diagnosis did not differ significantly from month to month in 2020.
The median survival rate during COVID-19 was 6.7 months (95% CI, 5.4-not reached) compared with 7.9 months (95% CI, 4.7–12) before COVID-19, with a median follow-up of 10.4 months. That overall survival data, however, remains unconventional.
The 30-day mortality rate in patients with neonatal NSCLC increased significantly with the spread of disease from 25% before COVID-19 to 49% during COVID-19. With new SCLC studies, the 30-day mortality rate jumped from 18% pre-COVID-19 to 32% during COVID-19.
“The COVID-19 pandemic is likely to last for a very long time, so we need to make a special effort to ensure that our patients have cancer and cancer treatment,” Reyes said.
Heather Wakelee, MD, of Stanford University Medical Center in California, said during the meeting that, due to the decline in diagnosis and later rates of lung cancer detection in these patients, it will bring us more challenges. The study will continue to evaluate the impact of COVID-19 on lung cancer studies and long-term prognoses.
Information
Reyes R, López-Castro R, Auclin E, et al. Pandemic Effect of COVID-19 in the Diagnosis and Prognosis of Lung Cancer. Presented at: Singapore 2020 World Conference on Lung Cancer; January 28-31; Virtually. Minutes 3700.