ABSTRACT
Introduction: In Portugal, in 2020, 5415 new lung cancer patients were diagnosed and 4797 deaths were caused by lung cancer. Lung cancer ranks third in terms of cancer incidence and is the leading cause of cancer mortality. Early diagnosis, complete and fast patient assessment and staging, multidisciplinary approach, access to personalized medicine, new treatment options and research are essential to improve survival and quality of life. Access to clinical trials is critical for this improvement.The aim of this study is to assess the techniques available to the diagnostic work-up, treatments, the waiting time and the needs perceived by physicians. Methods: The Portuguese Lung Cancer Study Group launched a survey in order to study the diagnostic approach and treatment of lung cancer patients in Portugal. An online survey with 47 questions was sent to all Portuguese hospitals that treat lung cancer, referring to the pre-COVID-19 pandemic experience. Results: Responses from 31 Portuguese hospitals were collected, between May and September 2020. Availability to bronchoscopy, image-guided transthoracic needle biopsy (TNB), endobronchial ultrasound- transbronchial needle aspiration (EBUS-TNBA), PET/CT, molecular biology testing is presented in table I. In 58% (n=18) the molecular biology test was performed as a "reflex test". About 68% (n=21) of hospitals used next generation sequencing. Two hospitals (7%) reported not having access to liquid biopsies.Video-assisted thoracoscopic surgery was the main surgical technique (61%;n=19). The waiting time for the first radiation oncology consultation was less than 15 days in 71% (n=26). About 61% (n=19) of hospitals had clinical trials. A wide majority of doctors (77%) would like to have more clinical trials. In 71% (n=22) of the hospitals, it was possible to refer patients to Palliative Care receiving systemic anticancer therapy. [Formula presented] Conclusions: Despite the limitations of the methods, this study allowed us to deepen our knowledge about the work-up technologies and treatments available for lung cancer patients in Portugal. It has also identified future opportunities, such as increasing accessibility to some diagnostic tools and clinical trials. Keywords: Diagnosis and treatment approach, Lung Cancer in Portugal, Health Services Research - Portugal
ABSTRACT
Introduction: The first patient with COVID-19 in Portugal was diagnosed on March 2. There was a lack of knowledge concerning the risks of COVID-19 infection in lung cancer patients, prognostic factors, the influence of cancer treatments and cure criteria. Treatments and consultations were readjusted in order to maintain the ones that increase patients’ survival, while reducing the risks of SARS-CoV-2 infection. International and national “guidelines” were followed, but each hospital had its own strategies to reduce COVID-19 risk. Purpose: The Portuguese Lung Cancer Study Group launched a survey in order to study the early impact of COVID-19 in lung cancer patients, changes in treatments and the way of implementation of COVID-free circuits. Methods: A survey was sent to lung cancer doctors of all the Portuguese hospitals. Results: At the data cut-off, information from twenty one hospitals was collected, corresponding to about 66% (n=3.446) of each year new diagnoses of lung cancer in Portugal. In March and April there was a reduction in newly lung cancer diagnosed patients while comparing with 2019: in March, 86% had a reduction;in April, 90% of the hospitals reported a reduction and it was greater than 40% in eight hospitals (38%). About 62% of the doctors considered less referral from primary care as a cause, and 33% delayed biopsies or other imaging exams. The most difficult exams to obtain were CT guided biopsies and EBUS for 48%. The majority of the hospitals (57%) were also referral for COVID-19 patients’ treatment. In 48% of the lung cancer treating departments’ there were doctors reallocated to COVID-19 treatment areas. In 48% the assistance teams were divided into teams that weren’t previously working together. The majority of doctors (90%) reported having individual protection equipment available. Hospitals performed teleconsultation (100%), and, in seven hospitals (33%), more than half of the consultations were done using communication technology. All the hospitals were able to perform SARS-CoV-2 testing. It was done before every cycle of chemotherapy in 90% of the hospitals. In the majority (67%) it was only performed before day D1, in D1 and D8 chemotherapy protocols. About 19% reported changes in prescription of adjuvant chemotherapy and in maintenance chemotherapy, 33% increased the prescription of oral chemotherapy, 33% changed the periodicity, 29% reported reduction in inclusion in clinical trials. In 33% there was an earlier end of chemotherapy in ECOG2 and vulnerable patients. In 38% the prescription of G-CSF (Granulocity-colony stimulating factor) increased, being used for prophylaxis if the risk of febrile neutropenia was more than 10-15%. The periodicity of consultations was changed for patients under TKI treatment in 86%, and 67% hospitals reported changes in immune checkpoint inhibitor treatment schedule. In 29% oral drugs could be delivered at patients’ home. All the patients admitted for surgery were tested for SARS-CoV-2, and 86% performed SARS-COV-2 testing before radiotherapy. Conclusion: Portuguese hospitals responded to the sudden need of creation of COVID-free circuits, change protocols and even teleconsultation. With a larger follow up we will study the late consequences of COVID-19 pandemic in lung cancer diagnosis and treatment. Keywords: COVID-19, survey, Portuguese Lung Cancer Study Group