The COVID-19 pandemic has had a profound impact on healthcare, especially in the management of patients with cancer, who are often not seeking healthcare in the same way as before the pandemic. At the 2021 International Association for the Study of Lung Cancer (IASLC) meeting, experts discussed the implications for patients with lung cancer, specifically.
“We are unfortunately diagnosing more patients with lung cancer at later stages because of the pandemic. That is going to create some ongoing issues for all of us,” stated IASLC President-Elect Heather A. Wakelee, MD, Deputy Director, Stanford Cancer Institute, CA.
Dr Wakelee commented on a study that compared data collected just before and during the COVID-19 pandemic and was presented at IASLC by Roxana Reyes, MD, Medical Oncology Department, Hospital Clínic de Barcelona, Spain.
During the early first-wave months of the pandemic, COVID-19 significantly affected Spain, Dr Reyes said. Disease severity and mortality increased in patients with cancer overall, and patients with lung cancer were at particularly high risk.
Because of concern that the healthcare system’s priorities to serve and manage patients with COVID-19 may be interfering with initial cancer diagnoses, and knowing that delaying cancer treatment is associated with increased mortality, Dr Reyes and her colleagues designed a study to assess the impact of COVID-19 on patients with lung cancer.
They retrospectively examined the clinical and biological data, and compared the incidence, severity, and outcomes of new cases of lung cancer diagnosed in 2020 with those from 2019 at 2 tertiary hospitals in Spain.
The study’s primary end points were the differences in the number of new cases of lung cancer and the disease severity (ie, performance status, disease stage, significant complications at diagnosis) from January 2019 to June 2019 and from January 2020 to June 2020. The secondary end point was the 30-day mortality rates during the same periods, separated by histology—small-cell lung cancer (SCLC) and non–small-cell lung cancer (NSCLC).
The overall study included 162 patients with newly diagnosed lung cancer, 100 patients before the COVID-19 pandemic (in 2019) and 62 patients during the pandemic (in 2020). The 62 patients diagnosed during the pandemic represent a 38% decline in lung cancer diagnoses. Among the total study population, 68% had NSCLC and 32% had SCLC.
In an analysis of the histology groups (which included 10 additional patients), patients with NSCLC during COVID-19 had increased oncology-related emergencies compared with before COVID-19 (5% vs 2%, respectively), hospitalizations (21% vs 18%), deaths during hospitalization (44% vs 17%), advanced disease (58% vs 46%), more than 2 metastatic sites (16% vs 12%), and symptomatic disease (74% vs 63%).
Although there was a similar reduction (–42%) in new cases of SCLC diagnosed during COVID-19 in 2020 compared with 2019, an increase in severe cases was not observed.
The survival data are immature, but the median overall survival was shorter during the pandemic than before the pandemic (6.7 months vs 7.9 months, respectively), and the 30-day mortality rates increased during COVID for patients with NSCLC (49% vs 25%, respectively) and for patients with SCLC (32% vs 18%, respectively).
Based on this study, fewer cases of lung cancer are being diagnosed, and more symptomatic and severe cases of NSCLC with poor outcomes are being diagnosed, with higher 30-day mortality rates.
“The take-home message is that in our descriptive study, lung cancer diagnosis is being affected during the COVID-19 pandemic,” Dr Reyes said. “Strategies for maintaining cancer diagnoses during the COVID-19 pandemic need to be implemented; this study is still ongoing to assess long-term impacts,” she advised.