ABSTRACT
Introduction: Diagnostic delays caused by the COVID-19 pandemic are predicted to increase avoidable deaths due to lung cancer in the UK. This project compared diagnostic pathways for cases of lung cancer registered at a large UK hospital before and during the pandemic. Methods: A retrospective analysis of cases of lung cancer registered at the Royal Derby Hospital, UK, was performed. Cases were divided by date of referral into pre-COVID (1/1/18-28/2/2020) and during COVID (1/3/2020-31/3/2021) groups then further by year and quarter. Case demographics, stage at diagnosis and treatment modalities were compared using descriptive statistics. Results: Of the 1220 cases examined, 806 were referred pre and 414 during COVID. Median referral caseload per quarter was 104 but decreased to 70 in the first quarter (Jan-March) of 2020 and 2021. Compared to pre-COVID, cases registered during were older (74.3 vs 72.9 years;p=0.04) with a worse performance status (PS) at referral (PS 0-1: 55.7% vs 64.2%;p=0.004). The proportion referred via the GP was significantly lower during COVID (31.6% during vs. 38.7% pre;p=0.015). The median time from referral to diagnosis improved during COVID to 18 from 25 days. No difference in the proportion of cases diagnosed with stage I-II disease (30.7% during, 31.7% pre) or histological confirmation rate (66.7% during, 70.7% pre;p=0.15) was observed. The proportion of patients receiving active treatment (58.8% during, 61.7% pre;p=0.34) or referral for surgical intervention did not change (24.2% during, 23% pre). Conclusions: Despite a decrease in referrals and a less favourable PS at presentation during the pandemic, no change in stage distribution nor treatment rates were detected. This may reflect sustained diagnostic capacity in our service due to pathway changes introduced pre-pandemic based on National Optimal Lung Cancer pathway (NOLCP) recommendations. It reinforces the need to implement NOLCP across all lung cancer services.
ABSTRACT
The COVID-19 pandemic forced governments around the world to impose restrictions on daily life to prevent the spread of the virus. This resulted in unprecedented reductions in anthropogenic activity, and reduced emissions of certain air pollutants, namely oxides of nitrogen. The UK 'lockdown' was enforced on 23/03/2020, which led to restrictions on movement, social interaction, and 'non-essential' businesses and services. This study employed an ensemble of measurement and modelling techniques to investigate changes in air quality, atmospheric composition and boundary layer reactivity in the South East of the UK post-lockdown. The techniques employed included in-situ gas- and particle-phase monitoring within central and local authority air quality monitoring networks, remote sensing by long path Differential Optical Absorption Spectroscopy and Sentinel-5P's TROPOMI, and detailed 0-D chemical box modelling. Findings showed that de-trended NO2 concentrations decreased by an average of 14-38% when compared to the mean of the same period over the preceding 5-years. We found that de-trended particulate matter concentrations had been influenced by interregional pollution episodes, and de-trended ozone concentrations had increased across most sites, by up to 15%, such that total Ox levels were roughly preserved. 0-D chemical box model simulations showed the observed increases in ozone concentrations during lockdown under the hydrocarbon-limited ozone production regime, where total NOx decreased proportionally greater than total non-methane hydrocarbons, which led to an increase in total hydroxyl, peroxy and organic peroxy radicals. These findings suggest a more complex scenario in terms of changes in air quality owing to the COVID-19 lockdown than originally reported and provide a window into the future to illustrate potential outcomes of policy interventions seeking large-scale NOx emissions reductions without due consideration of other reactive trace species.