ABSTRACT
State of the matterDue to the COVID-19 pandemic, and the resulting bottlenecks in the French healthcare system, the management of patients with COVID-19 has been prioritized over that of patients with other pathologies, in particular chronic diseases. The objective of this study was to investigate the impact of COVID-19 on the discovery stage of cancers diagnosed in an organized breast cancer screening program, as well as the impact on the time to supported. Material and methodsAll women aged 50 to 74 for whom cancer has been diagnosed in Cote d'Or as part of the national organized breast cancer screening program (first or second reading) from January 1, 2019 to December 31, 2020 have were included in this study. Using data from pathological anatomy laboratories, clinical centers, and the breast and gynecological cancer registry in Cote d'Or, France, we collected sociodemographic, clinical, and treatment data from all patients. We compared data from the year 2019 (pre-COVID) with that of the year 2020 (COVID). ResultsIn this study, we did not observe any change in the stage of discovery of the cancer at the time of diagnosis, nor any change in the therapeutic strategy. However, we observed a significant increase in infiltrated tumors, a decrease in in situ tumors, and the finding of larger clinical size of in situ tumors after the COVID pandemic. ConclusionWhile these results are reassuring, continued monitoring is needed to determine post-pandemic effects.
ABSTRACT
État de la question En raison de la pandémie de COVID-19, et de l'engorgement du système de santé français qui en a résulté, la prise en charge des patients atteints de la COVID-19 a été privilégiée par rapport à celle des patients atteints d'autres pathologies, notamment de maladies chroniques. L'objectif de cette étude était d'étudier l'impact de la COVID-19 sur le stade de découverte des cancers diagnostiqués dans le cadre d'un programme de dépistage organisé du cancer du sein, ainsi que l'impact sur le délai de prise en charge. Matériel et méthodes Toutes les femmes âgées de 50 à 74 ans pour lesquelles un cancer a été diagnostiqué en Côte d'Or dans le cadre du programme national de dépistage organisé du cancer du sein (première ou deuxième lecture) du 1er janvier 2019 au 31 décembre 2020 ont été incluses dans cette étude. À partir des données des laboratoires d'anatomie pathologique, des centres cliniques et du registre des cancers du sein et gynécologiques de la Côte d'Or, en France, nous avons recueilli les données sociodémographiques, cliniques et de traitement de tous les patients. Nous avons comparé les données de l'année 2019 (avant COVID) avec celles de l'année 2020 (COVID). Résultats Dans cette étude, nous n'avons pas observé de changement dans le stade de découverte du cancer au moment du diagnostic, ni de changement dans la stratégie thérapeutique. Cependant, nous avons observé une augmentation significative des tumeurs infiltrées, une diminution des tumeurs in situ, et la découverte d'une plus grande taille clinique des tumeurs in situ après la pandémie de COVID. Conclusion Bien que ces résultats soient rassurants, une surveillance continue est nécessaire pour déterminer les effets postpandémie.
ABSTRACT
Background: Non-Hodgkin lymphoma (NHL) is the largest group of hematological malignancies and represented 12% of all new cancer cases in metropolitan France in 2018. The survival outcomes of NHL patients have improved due to important therapeutic advances. Age-standardized 5-year net survival from 2010 to 2015 in France was 86% for follicular lymphoma (FL) and 61% for diffuse large B cell lymphoma (DLBCL), which are above the average survival rates in Europe (FL 72% and DLBCL 51%). In this context, the question of quality of life in NHL patients is garnering increasing interest. To the best of our knowledge, few data from France have addressed the issue of living conditions of long-term NHL survivors at the scale of the general population. Aims: To identify the clinical and social determinants of long-term health related quality of life (HRQoL) in NHL survivors in the general population and to describe their socio-professional reintegration, socio-economic status, sexual wellbeing and the impact of COVID. Methods: All patients were registered in the population-based cancer registry specialized in hematological malignancies in the Côte d'Or area (A French Department with a total of 532,901 residents in 2019). We identified patients diagnosed with DLBCL or FL according to the third edition of the International Classification of Diseases for Oncology (ICD-O- 3), from January 1st 2010 to December, 31st 2017, and who were still alive on March, 1st 2021, with an updated address. Patients under 18 years old and adults unable to provide consent were not eligible. In March 2021, patients completed standardized self-report questionnaires for HRQoL (SF-12), anxiety and depression (HADS), social support (SSQ6), socio-economic deprivation (EPICES). Reminders were sent to non-responders after one month. The determinants of HRQoL were identified using a generalized linear model. Results: Among 436 patients diagnosed, 248 were alive at the study endpoint, of whom 157 (FL 51% and DLBCL 49%) completed the questionnaires, yielding a response rate of 63.3%, the median of time since diagnosis was 76 months [39-133]. The mean age of participants was 67.3 years (SD = 12.4), 55% were men, 74% Ann Arbor stage III-IV, 78% were treated by chemotherapy and immunotherapy, with 99% in the DLBCL group, 11% relapsed after treatment, 64% had no comorbidities and 62% did not have socio-economic deprivation, 27% were employed at the time of the survey, 60% of survivors had not received information about sexuality, 29% reported a negative impact of the disease on their professional activities, 54% reported an impact of the COVID crisis on their life. This impact was socio-economic for 77% and psychological for 23% of respondents. The main factors associated with a negative impact on HRQoL were depression, anxiety, and loss of sexual desire. Summary/Conclusion: Six years after diagnosis, clinical parameters did not have a major influence on HRQoL, except for relapse. The main determinants of HRQoL identified were psychological and social factors. All these elements are potential targets for specific interventions by the social system to improve HRQoL in NHL patients.