The Negative Impact of the COVID-19 Pandemic on Oncology Care at an Academic Cancer Referral Center.

Objectives: COVID-19 created unexpected delays in oncologic treatment. This study sought to assess the volume of missed cancer-related services due to the pandemic. Methods: This case-controlled trial evaluated more than 345,000 oncologic clinic, lab, and radiation appointments from January 1, 2019, through December 31, 2020, and surgery appointments from January 1, 2019, through October 31, 2020. All patients at the Seidman Cancer Center with a cancer diagnosis based on a comprehensive list of 2178 International Classification of Diseases, Ninth Edition (ICD-9) and ICD-10 codes were included in the analysis. Subgroup analyses based on age, race, and sex were also performed. Results: Clinic, lab, and surgical visit cancellations increased by 4.20% (P <.001), 4.84% (P <.001), and 5.22% (P <.001), respectively. In the first 10 months of 2020, there were 703 (9.2%) fewer surgeries compared with the same time period in 2019. The following cancellation rates peaked in March 2020: clinic visits (26.53%), labs (43.66%), surgery (34.00%). Radiation oncology (12.53%) cancellations peaked in April 2020. Prior to the emergence of COVID-19, the group aged 0 to 39 years had the highest clinic cancellation rate (17.85%) compared with patients aged 40 to 64 years (15.95%) and 65 years and older (14.52%; P <.001). Men cancelled (15.63%) significantly more often than women (14.93%; P <.001) in 2019. This reversed during the pandemic: Women (19.56%) cancelled more frequently than men (19.20%; P <.036). Conclusions: There was a large increase in cancelled oncologic care in 2020, which has implications for delayed diagnosis and treatment. This was especially true for patients older than 65 years and for women. These delays could result in patients presenting with more advanced disease, complicating morbidities, and ultimately worse long-term outcomes.

Upfront Multigene Panel Testing for Cancer Susceptibility in Newly Diagnosed Endometrial Cancer Patients: A Prospective Cohort Study (preprint)

Background: Lynch syndrome (LS) is the most common cause of hereditary endometrial cancer (EC). Screening EC patients for LS varies by institution and current strategies employ tumor testing and/or family history approaches. Ultimately a LS diagnosis is made by genetic testing. In this study, we evaluated upfront multi-gene panel testing (MGPT) in unselected ECs for improved identification of LS and to determine the frequency of pathogenic variants (PVs) in other cancer susceptibility genes (CSGs).  Methods: EC patients were prospectively enrolled at nine Ohio institutions, 10/1/2017 - 12/31/2020. All patients had clinical germline testing for forty-seven CSGs. Mismatch repair (MMR) immunohistochemistry (IHC), MLH1 methylation and clinicopathologic data were abstracted from patients’ records. Detailed family history data were obtained for all subjects.  Findings: 29 of 961 EC patients (3·1%, 95% CI 2·1 – 4·3%) were found to have LS. <i>PMS2</i> PVs were most frequent (11/29), followed by MSH6 (10/29), <i>MSH2</i> (6/29), and  <i>MLH1</i> (2/29). Tumor IHC was concordant for all <i>MLH1</i> and  <i>MSH2</i>, and 9/10 MSH6 heterozygotes. For  <i>PMS2</i>, tumor IHC and germline status concordance was 80% and family history was not predictive of LS. An additional 68 (7·1%) women had likely pathogenic (LP) or PVs in 16 other CSGs. Twenty-one patients had LP/PVs in high penetrance CSGs. Of note, 10 patients (1·04%) had PVs in <i>BRCA1</i> or <i>BRCA2</i>, with a significant excess of type-II ECs among  <i>BRCA</i> heterozygotes.    Interpretation: Prospective MGPT in a large, unselected EC cohort revealed that a majority of LS diagnoses are attributable to low-penetrance genes. MGPT substantially increased LS diagnoses by capturing patients who had equivocal IHC findings or for whom tumor screening was not performed. The finding that 97/961 (10%) women in this cohort have actionable CSG variants supports a role for upfront MGPT for all women with EC.  Funding: This research was funded by an Ohio State University James Comprehensive Cancer Center Statewide Pelotonia Cancer Impact Award. Declaration of Interest: HH is on the scientific advisory boards for Invitae Genetics, Promega, and Genome Medical. HH has stock/stock options in Genome Medical and GI OnDemand, outside of the submitted work. DC is a COVID response consultant for Kane Logistics, he receives honoraria as Deputy Editor of Gynecologic Oncology and as an author for Up to Date, and he also holds patents: 1) “MicroRNA-based methods and compositions for the diagnosis, prognosis and treatment of ovarian cancer using a real-time PCR platform” Patent number 9,499,869 B2, issued November 22, 2016 Cohn DE, Alder HJ, Croce C, Resnick KE; 2) “Chimeric VEGF peptides” Patent number 8,080,253 B2, issued December 20, 2011 Kaumaya PTP, Cohn DE, all outside of the submitted work. JMs wife is employed by Pfizer Inc. JN declares consulting roles for AstraZeneca, Curio, and Clovis Oncology; speakers’ bureau for Clovis oncology and Merck; and has received a research grant from Zodus Medical Inc, all outside of the submitted work. CB has received honoraria as a speaker for OncLive and for an oral boards review course by Perinatal services, outside of the submitted work. SS reports speakers’ bureaus for AstraZeneca and Merck, outside of the submitted work. KR’s partner is SS with previously listed disclosures. PJG received an award from Promega, outside of the submitted work. MDL, RP, CC, AC, AS, DB, SW, SA, EJ, AC, and RN declare no competing interests. Ethical Approval: The study was approved by the Institutional Review Boards (IRBs) at each participating center with OSU serving as IRB of record.