ABSTRACT
The COVID-19 pandemic has enforced drastic changes in dermatological practice with skin cancer services prioritized. Two-week-wait referrals from April to May 2019 were compared with the same period from 2020 - at the height of the pandemic - and analysed using Stata version 16 in order to inform a long-term change in practice. There were 695 referrals across both years (4 months);441 (63.4%) in 2019 and 254 (36.5%) in 2020. The rate of attendance was higher in 2019 (pre-COVID-19): 418 (95%) vs. 227 (90%) in 2020 (P = 0.008). Mean patient age in 2019 was 56 years and in 2020 it was 52 years. There was no change in sex distribution. Among the attendees, 45.3% required a biopsy. The rate of biopsy requirement was lower in 2020 than in 2019 (38% vs. 49%;P = 0.007);however, more of the biopsies were carried out on the day in 2020 than in 2019 (33% vs. 11%;P < 0.001). The most common reason for not performing a biopsy in those requiring one in 2019 was due to elective booking (85%);however, in 2020 there were only 10 patients who did not have a biopsy when one was required and the reasons were mainly unknown. Across both years, there were 17 histologically confirmed cases of malignant melanoma: 2.6% of all attendees. This rate was slightly higher in 2020 (3.1% vs. 2.4%) but was not statistically significant (P = 0.6). The rated of basal cell carcinoma, squamous cell carcinoma and other malignancies were 6.8%, 5.1% and 5.9%, respectively, and were not statistically significant different between 2019 and 2020. The rate of melanocytic naevus was 6.2% and other melanocytic lesions was 1.1%. The rate of histological confirmation of 'other benign' conditions was 14.6%;this was significantly lower in 2020 (9.3%) compared with 2019 (17.5%;P = 0.005). Overall, 47% were discharged on the same day;57.6% in 2020 vs. 40.7% in 2019 (P < 0.001). Among those requiring follow-up, the majority in 2019 had face-to-face appointments (56%);however, in 2020 the majority had telephone appointments (65%), which was statistically significant (P = 0.001). Our data suggest that the changes incurred by COVID-19 have driven a more effective and accurate skin cancer service;similar amounts of malignancies were identified with a simultaneous reduction in biopsy-proven benign conditions. In the future, there is an important role for on-the-day biopsies with more telephone follow-up consultations.
ABSTRACT
BACKGROUND: Cancer patients are regarded as a highly vulnerable group in the current Coronavirus Disease 2019 (COVID-19) pandemic. To date, the clinical characteristics of COVID-19-infected cancer patients remain largely unknown. PATIENTS AND METHODS: In this retrospective cohort study, we included cancer patients with laboratory-confirmed COVID-19 from three designated hospitals in Wuhan, China. Clinical data were collected from medical records from 13 January 2020 to 26 February 2020. Univariate and multivariate analyses were carried out to assess the risk factors associated with severe events defined as a condition requiring admission to an intensive care unit, the use of mechanical ventilation, or death. RESULTS: A total of 28 COVID-19-infected cancer patients were included; 17 (60.7%) patients were male. Median (interquartile range) age was 65.0 (56.0-70.0) years. Lung cancer was the most frequent cancer type (n = 7; 25.0%). Eight (28.6%) patients were suspected to have hospital-associated transmission. The following clinical features were shown in our cohort: fever (n = 23, 82.1%), dry cough (n = 22, 81%), and dyspnoea (n = 14, 50.0%), along with lymphopaenia (n = 23, 82.1%), high level of high-sensitivity C-reactive protein (n = 23, 82.1%), anaemia (n = 21, 75.0%), and hypoproteinaemia (n = 25, 89.3%). The common chest computed tomography (CT) findings were ground-glass opacity (n = 21, 75.0%) and patchy consolidation (n = 13, 46.3%). A total of 15 (53.6%) patients had severe events and the mortality rate was 28.6%. If the last antitumour treatment was within 14 days, it significantly increased the risk of developing severe events [hazard ratio (HR) = 4.079, 95% confidence interval (CI) 1.086-15.322, P = 0.037]. Furthermore, patchy consolidation on CT on admission was associated with a higher risk of developing severe events (HR = 5.438, 95% CI 1.498-19.748, P = 0.010). CONCLUSIONS: Cancer patients show deteriorating conditions and poor outcomes from the COVID-19 infection. It is recommended that cancer patients receiving antitumour treatments should have vigorous screening for COVID-19 infection and should avoid treatments causing immunosuppression or have their dosages decreased in case of COVID-19 coinfection.