Decrease of visits and hospital admissions for cancer patients during the COVID-19 pandemic. A systematic review and meta-analysis.

Background: During the COVID-19 pandemic, many nonurgent oncologic services were postponed. The aim of the present study was to estimate the impact of the pandemic on visits and hospital admissions for cancer patients worldwide. Methods: In our systematic review and meta-analysis, databases such as Pubmed, Proquest, and Scopus were searched comprehensively for articles published between January 1, 2020, and December 12, 2021. We included articles reporting data comparing the number of visits and hospital admissions for oncologic patients performed before and during the pandemic. Two pairs of independent reviewers extracted data from the selected studies. The weighted average of the percentage change was calculated and compared between pandemic and pre-pandemic periods. Stratified analysis was performed by geographic area, time interval, and study setting. Findings: We found a mean relative change throughout January-October 2020 of -37.8% (95% CI -42.6; -32.9) and -26.3% (95% CI -31.4; -21.1) compared to pre-pandemic periods for oncologic visits and hospital admission, respectively. The temporal trend showed a U-shaped curve with nadir in April for cancer visits and in May 2020 for hospital admissions. All geographic areas showed a similar pattern and the same was observed when stratifying the studies as clinic-based and population-based. Interpretation: Our results showed a decrease in the number of visits and hospital admission during the January-October 2020 period after the outbreak of the COVID-19 pandemic. The postponement or cancellation of these oncologic services may negatively affect the patient's outcome and the future burden of disease. Supplementary Information: The online version contains supplementary material available at 10.1007/s10389-023-01857-w.

Decrease of visits and hospital admissions for cancer patients during the COVID-19 pandemic. A systematic review and meta-analysis

Background During the COVID-19 pandemic, many nonurgent oncologic services were postponed. The aim of the present study was to estimate the impact of the pandemic on visits and hospital admissions for cancer patients worldwide. Methods In our systematic review and meta-analysis, databases such as Pubmed, Proquest, and Scopus were searched comprehensively for articles published between January 1, 2020, and December 12, 2021. We included articles reporting data comparing the number of visits and hospital admissions for oncologic patients performed before and during the pandemic. Two pairs of independent reviewers extracted data from the selected studies. The weighted average of the percentage change was calculated and compared between pandemic and pre-pandemic periods. Stratified analysis was performed by geographic area, time interval, and study setting. Findings We found a mean relative change throughout January–October 2020 of –37.8% (95% CI –42.6;–32.9) and –26.3% (95% CI –31.4;–21.1) compared to pre-pandemic periods for oncologic visits and hospital admission, respectively. The temporal trend showed a U-shaped curve with nadir in April for cancer visits and in May 2020 for hospital admissions. All geographic areas showed a similar pattern and the same was observed when stratifying the studies as clinic-based and population-based. Interpretation Our results showed a decrease in the number of visits and hospital admission during the January–October 2020 period after the outbreak of the COVID-19 pandemic. The postponement or cancellation of these oncologic services may negatively affect the patient's outcome and the future burden of disease. Supplementary Information The online version contains supplementary material available at 10.1007/s10389-023-01857-w.

Decrease of cancer diagnosis during COVID-19 pandemic: a systematic review and meta-analysis.

Many health services, including cancer care, have been affected by the COVID-19 epidemic. This study aimed at providing a systematic review of the impact of the epidemic on cancer diagnostic tests and diagnosis worldwide. In our systematic review and meta-analysis, databases such as Pubmed, Proquest and Scopus were searched comprehensively for articles published between January 1st, 2020 and December 12th, 2021. Observational studies and articles that reported data from single clinics and population registries comparing the number of cancer diagnostic tests and/or diagnosis performed before and during the pandemic, were included. Two pairs of independent reviewers extracted data from the selected studies. The weighted average of the percentage variation was calculated and compared between pandemic and pre-pandemic periods. Stratified analysis was performed by geographic area, time interval and study setting. The review was registered on PROSPERO (ID: CRD42022314314). The review comprised 61 articles, whose results referred to the period January-October 2020. We found an overall decrease of - 37.3% for diagnostic tests and - 27.0% for cancer diagnosis during the pandemic. For both outcomes we identified a U-shaped temporal trend, with an almost complete recovery for the number of cancer diagnosis after May 2020. We also analyzed differences by geographic area and screening setting. We provided a summary estimate of the decrease in cancer diagnosis and diagnostic tests, during the first phase of the COVID-19 pandemic. The delay in cancer diagnosis could lead to an increase in the number of avoidable cancer deaths. Further research is needed to assess the impact of the pandemic measures on cancer treatment and mortality.

Global Association of COVID-19 Pandemic Measures with Cancer Treatment: A Systematic Review and Meta-Analysis.

IMPORTANCE: The COVID-19 pandemic has put a serious strain on health services, including cancer treatment. OBJECTIVE: This study aimed to investigate the changes in cancer treatment worldwide during the first phase of the SARS-CoV-2 outbreak. DATA SOURCES: Pubmed, Proquest, and Scopus databases were searched comprehensively for articles published between 1 January 2020 and 12 December 2021, in order to perform a systematic review and meta-analysis conducted following the PRISMA statement. STUDY SELECTION: Studies and articles that reported data on the number of or variation in cancer treatments between the pandemic and pre-pandemic periods, comprising oncological surgery, radiotherapy, and systemic therapies, were included. DATA EXTRACTION AND SYNTHESIS: Data were extracted from two pairs of independent reviewers. The weighted average of the percentage variation was calculated between the two periods to assess the change in the number of cancer treatments performed during the pandemic. Stratified analyses were performed by type of treatment, geographic area, time period, study setting, and type of cancer. RESULTS: Among the 47 articles retained, we found an overall reduction of -18.7% (95% CI, -24.1 to -13.3) in the total number of cancer treatments administered during the COVID-19 pandemic compared to the previous periods. Surgical treatment had a larger decrease compared to medical treatment (-33.9% versus -12.6%). For all three types of treatments, we identified a U-shaped temporal trend during the entire period January-October 2020. Significant decreases were also identified for different types of cancer, in particular for skin cancer (-34.7% [95% CI, -46.8 to -22.5]) and for all geographic areas, in particular, Asia (-42.1% [95% CI, -49.6 to -34.7]). CONCLUSIONS AND RELEVANCE: The interruption, delay, and modifications to cancer treatment due to the COVID-19 pandemic are expected to alter the quality of care and patient outcomes.

Global Association of COVID-19 Pandemic Measures With Cancer Screening: A Systematic Review and Meta-analysis.

Importance: Public health services, including cancer screening tests, have been affected by the onset of the COVID-19 epidemic. Objective: To investigate the pandemic's association with cancer screening worldwide. Data Sources: In this systematic review and meta-analysis, databases such as PubMed, ProQuest, and Scopus were searched comprehensively for articles published between January 1, 2020, and December 12, 2021. Study Selection: Observational studies and articles that reported data from cancer registries that compared the number of screening tests performed before and during the pandemic for breast, cervical, and colorectal cancer were included. Data Extraction and Synthesis: Two pairs of independent reviewers extracted data from the selected studies. The weighted average of the percentage variation was calculated between the 2 periods to assess the change in the number of cancer screening tests performed during the pandemic. Stratified analysis was performed by geographic area, period, and type of setting. The systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Main Outcomes and Measures: The main outcome was the weighted average percentage variation in the number of screening tests performed between January and October 2020 compared with the previous period. Results: The review comprised 39 publications. There was an overall decrease of -46.7% (95% CI, -55.5% to -37.8%) for breast cancer screening, -44.9% (95% CI, -53.8% to -36.1%) for colorectal cancer screening, and -51.8% (95% CI, -64.7% to -38.9%) for cervical cancer screening during the pandemic. For all 3 cancers, a U-shaped temporal trend was identified; for colorectal cancer, a significant decrease was still apparent after May 2020 (in June to October, the decrease was -23.4% [95% CI, -44.4% to -2.4%]). Differences by geographic area and screening setting were also identified. Conclusions and Relevance: A summary estimate of the downscaling of cancer screening tests since the onset of the COVID-19 pandemic is provided in this systematic review and meta-analysis. This could be associated with an increase in the number of avoidable cancer deaths. Effective interventions are required to restore the capacity of screening services to the prepandemic level.

Outcome of SARS CoV-2 inpatients treated with convalescent plasma: One-year of data from the Veneto region (Italy) Registry.

OBJECTIVES AND BACKGROUND: Convalescent plasma (CP) has been used worldwide to contrast SARS-CoV-2 infection. Since April 2020, it has also been used in the treatment of patients with COVID-19 in the Veneto region (Italy), along with all the other available drugs and therapeutic tools. Here we report data analysis and clinical results in 1,517 COVID-19 inpatients treated with CP containing high-titre neutralizing anti-SARS-CoV-2 antibodies (CCP). Mortality after 30 days of hospitalization has been considered primary outcome, by comparing patients treated with CCP vs all COVID-19 patients admitted to hospitals of the Veneto region in a one-year period (from April 2020 to April 2021). PATIENTS AND METHODS: Adult inpatients with a severe form of COVID-19 have been enrolled, with at least one of the following inclusion criteria: 1) tachypnea with respiratory rate (RR) ≥ 30 breaths/min; 2) oxygen saturation (SpO2) ≤ 93% at rest and in room air; 3) partial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2) ≤ 200 mmHg, 4) radiological picture and/or chest CT scan showing signs of interstitial disease and/or rapid progression of lung involvement. Patients received a maximum of three therapeutic fractions (TFs) of CCP with a neutralizing antibody titre of ≥ 1:160, administered over a period of 3-5 days. If TFs of CCP with titre ≥ 1:160 were unavailable, 2 with antibody titre of ≥ 1:80 have been administered. RESULTS: Of the 1,517 patients treated with CCP, 209 deceased at the 30-day follow-up (14%). Death was significantly associated with an older age (p<0.001), a longer time of hospitalization before CCP infusion (p<0.001), a greater number of inclusion criteria (p<0.001) and associated comorbidities (p<0.001). Conditions significantly associated with an increased frequency of death were PaO2/FiO2 ≤ 200 (p<0.001) and tachypnea with RR>30 (p<0.05) at entry, concurrent arterial hypertension (p<0.001), cardiovascular disease (p<0.001), chronic kidney disease (p<0.001), dyslipidemia (p<0.05) and cancer (p<0.05). Moreover, factors leading to an unfavorable prognosis were a life-threatening disease (p<0.001), admission to Intensive Care Unit (p<0.001), high flow oxygen therapy or mechanical ventilation (p<0.05) and a chest X-ray showing consolidation area (p<0.001). By analyzing the regional report of hospitalized patients, a comparison of mortality by age group, with respect to our series of patients treated with CCP, has been made. Mortality was altogether lower in patients treated with CCP (14% v. 25%), especially in the group of the elderly patients (23% vs 40%,), with a strong significance (p<0.001). As regards the safety of CCP administration, 16 adverse events were recorded out of a total of 3,937 transfused TFs (0,4%). CONCLUSIONS: To overcome the difficulties of setting up a randomized controlled study in an emergency period, a data collection from a large series of patients with severe COVID-19 admitted to CCP therapy with well-defined inclusion criteria has been implemented in the Veneto region. Our results have shown that in patients with severe COVID-19 early treatment with CCP might contribute to a favourable outcome, with a reduced mortality, in absence of relevant adverse events.