ABSTRACT
Background: The coronavirus disease 2019 (COVID-19) had an unprecedent impact on the global health care system since March 2020. Lung cancer (LC) patients (pts) represent a vulnerable population, and diagnostic/therapeutic delays might affect the years to come. Aim of the multicenter, real-world, Italian COVID-DELAY study was to evaluate how the 2020 COVID-19 pandemic impacted on LC pts' access to diagnosis and treatment compared to pre-pandemic time. Patients and methods: All consecutive newly diagnosed LC pts referred to 25 Italian Oncology Departments between March and December 2020 were reviewed. Monthly access rate and temporal intervals between date of symptom onset, diagnosis and treatment start were analyzed and compared to the same period of 2019. Differences between the two years were analyzed using Fisher's exact test or chi-square test for categorical variables and unpaired Student t test, or the Mann-Whitney U test for continuous variables. Results: Less LC cases (1523 vs 1637, -6.9%) were diagnosed during the 2020 pandemic compared to 2019. LC pts in 2020 were more likely to be diagnosed with stage IV disease (p < 0.01) and to be current smokers (p < 0.01). A major drop of new LC cases was seen during the lockdown period (percentage drop -13.2% vs -5.1%) compared to the other months included. Moreover, a geographic migration was observed with more LC patients referring to low/ medium volume hospital in 2020 compared to 2019 (p = 0.01). Looking at pts management, no differences emerged in terms of interval between symptom onset and radiological diagnosis (p = 0.94), symptom onset and cytohistological diagnosis (p = 0.92), symptoms onset and treatment start (p = 0.40), treatment start and first radiological revaluation (p = 0.36). However, less LC patients were treated in the context of clinical trials during 2020 (5% vs 7%, p = 0.07). Conclusions: Our study pointed out a decrease of new LC cases and a shift towards a higher stage at diagnosis in 2020. Despite this, the efforts put in place by the Italian Oncology Departments ensured the maintenance of the diagnostic-therapeutic pathways of LC patients.
ABSTRACT
Background: During the current COVID-19 pandemic, the use of protective masks is essential to reduce contagions. However, public opinion reports an associated subjective shortness of breath. We aimed to evaluate cardiorespiratory parameters, both at rest and during maximal exertion, to highlight any differences with the use of surgical masks and FFP2 masks compared to standard conditions in healthy subjects. Methods: Twelve subjects underwent three consecutive cardiopulmonary exercise tests (CPETs): without wearing protection mask, with surgical mask and with FFP2 mask (Figure 1). Subjects' degree of dyspnea was assessed by Borg Scale. Standard pulmonary function tests were performed at rest. Findings: All the subjects (40.8±12.4 years;6 male) completed the study protocol with no adverse event. At spirometry, from no mask to surgical to FFP2 a progressive reduction of FEV1 and FVC was observed (3.94±0.91L/s, 3.23±0.81L/s, 2.94±0.98L/ s and 4.70±1.21L, 3,77±1.02L, 3.52±1.21L, respectively, p<0.001) (Figure 2). Rest ventilation, O2 intake (VO2) and CO2 production (VCO2) were progressively lower due to a respiratory rate reduction. At peak exercise, subjects revealed a progressive higher Borg scale value when wearing surgical and FFP2 (Figure 3). At peak exercise VO2 (30.9±623.40, 27.50±6.92, 28.24±8.79ml/Kg/min, p=0.001), ventilation (92.29±25.99, 76.19±21.62, 71.63±21.19L, p=0.003), respiratory rate (41.52±8.02, 37.73±5.52, 37.11±4.53, p=0.04) and tidal volume (2.28±0.72, 2.05±0,60, 1.96±0.65L, p=0.001) were lower from no mask to surgical to FFP2. We did not observe a significant inter-group difference in oxygen sat-uration. Interpretation: Protective masks are associated with a significant but modest worsening spirometry and cardiorespiratory parameters at rest and peak exercise. The effect is driven by a ventilation reduction due to an increased air-flow resistance. However, since signs of exercise ventilatory limitation are far away to be reached, their use is safe even during maximal exercise, albeit with a slight reduction in performance.