ABSTRACT
Background: The reorganization of cancer care delivery during the COVID pandemic had the potential to catalyze improvement in CWR adherence by reducing provision of low value care to minimize in-person visits and mitigate potential issues with staff and resource shortages. We evaluated the impact of COVID on adherence with CWR for supportive care, relevant to colorectal and anal cancer patients with stage IV disease at Princess Margaret Cancer Centre (PM) in Canada and AC Camargo Cancer Center (AC) in Brazil. Method(s): Eligible patients had a new patient consult 02/2020- 12/2020 (COVID) or the same period in 2019 (control). Performance on individual CWR in the 6 months following initial consultation was calculated as the proportion of eligible patients meeting the recommendation. Result(s): The PM and AC cohorts each consisted of 100 patients;demographic and disease characteristics of COVID and control cohorts were similar within each centre. Marginally fewer patients received surgery during COVID (PM: 38.3 vs 49.1%, p = 0.28;AC: 54.8 vs 55.2%, p = 0.97). At PM, more patients received radiation therapy during COVID (36.2 vs 24.5%, p = 0.21), whereas the opposite occurred at AC (7.1 vs 17.2%, p = 0.14). A higher proportion of both PM and AC patients treated during COVID died within 6 months of initial consult than in 2019 (PM: 10.6 vs 7.5%, p = 0.015;AC: 21.4 vs 8.6%, p = 0.029). Adherence to selected CWR is summarized below;whereby a higher proportion means higher concordance with CWR. Conclusion(s): There was low overall adherence to CWR across both centers with no significant changes to patterns of care for patients with stage IV disease during the COVID-19 pandemic.
ABSTRACT
Background: The ongoing COVID-19 pandemic has disrupted worldwide cancer care delivery, leading to a decline in cancer screening, delayed diagnostic tests, and treatment modifications. Little has been reported on the care delivery impact of COVID-19 on patients (pts) with rare tumours, such as squamous cell carcinoma of the anus (SCCA). Our study aimed to evaluate the impact of the pandemic on care delivery of SCCA pts in two comprehensive cancer centres. Methods: We performed a retrospective study of two consecutive cohorts of adult pts diagnosed with SCCA at AC Camargo Cancer Center (AC) and Princess Margaret Cancer Center (PM) from the peri-COVID-19 period (1 February 2020- 31 January 2021) to the same period in the year prior (1 February 2019- 31 January 2020), utilizing electronic medical records to collect data on pts demographics and patterns of care in the six months following their first consultation. Comparisons of patterns of care between the peri- and pre-COVID-19 (control) cohorts were conducted using two-sided t-tests, Wilcoxon rank-sum tests, χ2 tests, or Fisher’s exact tests, as appropriate;p < 0.05 were deemed significant. Results: Overall, 73 pts were included: peri-COVID-19: n = 35 and pre-COVID-19: n = 38;both cohorts had similar demographic compositions in terms of age and sex [control: median age = 61.4 (IQR: 41.8 – 92.1), 55% female;peri-COVID-19: median age = 66.9 (IQR: 41-91.1), 63% female]. Pts from both institutions presented similar characteristics in both peri- and pre-COVID-19 periods. At AC, the number of pts diagnosed with SCCA during the peri-COVID-19 period was half of that prior to the pandemic. In the peri-COVID-19 period, the proportion of pts who received radiation therapy decreased in both institutions, when compared with the pre-pandemic period, however, the decrease was not found to be significant: 100% vs 83% at AC (p=0.32) and 84% vs 76% at PM (p=0.52). A similar proportion of pts received chemotherapy in the peri- and pre-COVID-19 periods, respectively: 80% vs 82%. Disease stage III at diagnosis was the most common (pre-COVID: 46%, peri-COVID: 46%). The proportion of pts who were operated on was similar between both cohorts (peri-COVID-19: 23%;control: 21%). Conclusions: Our multicenter study shows that during the peri-COVID-19 pandemic, the number of pts who received radiotherapy therapy to treat SCCA was numerically inferior, albeit not statistically significant. In one of the cancer centers, the number of new SCCA cases dropped by 50%. Longer follow-up is needed to understand the impact of the treatment modifications on SCCA clinical outcomes. Legal entity responsible for the study: The author. Funding: The study was funded by a grant from the Global Oncology Program at Princess Margaret Cancer Centre. Disclosures: All authors have declared no conflicts of interest.