Delayed visit and treatment of lung cancer during the coronavirus disease 2019 pandemic in Japan: a retrospective study.

OBJECTIVE: The impact of the coronavirus disease 2019 (COVID-19) pandemic on cancer care remains a concern. We aimed to evaluate access to diagnosis and treatment for lung cancer during the pandemic. METHODS: Times (days) from lung cancer symptom onset or referral to visit (pre-visit time), from visit to diagnosis (pre-diagnosis time), and from diagnosis to treatment (pre-treatment time) during the pandemic were compared with the times during the pre-pandemic period. RESULTS: The number of patients diagnosed with lung cancer was 82 and 75 during the pandemic and pre-pandemic periods, respectively. The percentage of patients with advanced-stage cancer was higher (65.9% vs. 46.7%), the percentage of patients treated with surgery was lower and the percentage treated with medication was higher (24.4% vs. 41.3% and 57.3% vs. 40.0%, respectively), the pre-visit time was longer (28.2 vs. 11.4 days), and the pre-treatment time for surgery was longer (67.3 vs. 45.6 days) during the pandemic compared with the times during the pre-pandemic period, respectively. CONCLUSIONS: The COVID-19 pandemic resulted in delayed diagnoses, which could have led to patients being diagnosed with advanced disease. The pandemic also resulted in delayed therapy owing to the requirement for available intensive care unit beds for emergencies, including surgery.

[Characteristics of 10 Cases of Community Transmission of COVID-19 Pneumonia]

Recently, cases of coronavirus disease 2019 (COVID-19) with unknown routes of transmission are being reported from various parts of Japan. When close contacts of infected patients present with symptoms, the index of suspicion for COVID-19 is high, and consultations and examinations are implemented with sufficient infection control measures in place. On the other hand, the possibility of COVID-19 is often difficult to consider initially in cases from the community presenting with upper respiratory tract symptoms, such as sore throat and cough, and/or fever. The initial upper respiratory tract symptoms are similar to those of common cold. It is only much later, usually about one week after the appearance of symptoms, that COVID-19 is suspected and the test for SARS-CovV-2 is performed. Until then, the patients may have consulted their family doctor and been tested for influenza, and may have been prescribed a cold medicine or antitussive. We encountered 10 cases of COVID-19 pneumonia that developed in the community and tested positive for SARS-CoV-2 by PCR. The presenting symptoms were a fever of over 38°C in 9 cases, nasal discharge in 1 case, sore throat in 4 cases, cough in 8 cases, sputum in 5 cases, shortness of breath in 6 cases, malaise in 7 cases, and gastrointestinal symptoms in 3 cases. Five cases also showed poor health and fever in the family. All cases needed 1-3 consultations to be finally diagnosed, and the interval from the appearance of symptoms to diagnosis was 5-12 days. Coarse crackles could be auscultated in only one case, and the SpO2 was more than 95% in 8 cases, and 80% in 2 cases. No increase of the peripheral white blood cell count was observed in any of the cases, and the blood lymphocyte count was less than 1,000/μL in 6 cases. The serum CRP showed only a slight increase to up to 5 mg/dL in 7 cases, and a slight increase in the d-dimer level was observed in 5 cases. In some cases, while it was difficult to detect abnormalities on the chest X-ray, chest computed tomography showed multiple bilateral ground-glass opacities, predominantly in the peripheral/subpleural regions, in all cases. Nine of the 10 patients also showed lesions in the lower right lobe. We describe the clinical characteristics of COVID-19 pneumonia among cases of infectious diseases encountered in the community. Based on the above, we suggest that in cases from the community presenting with fever and upper respiratory symptoms, one clue to suspecting COVID-19 is the presence of persons among family members who are also unwell.