Impact of the COVID-19 pandemic on digestive cancer staging, a case series.

Introduction: The COVID-19 pandemic had an undeniable impact on the health system worldwide, this lead to a delay in the diagnosis and treatment of digestive cancers.The purpose of our study was to assess this delay and its impact on patient care. Method: Our work is a retrospective study about 165 patients that were admitted for digestive cancers at Sheik Khalifa hospital, Casablanca morocco during a 3-year period, that we divided into three. We included all the digestive adenocarcinomas (esophagus excluded) whether they were operated on or not. We excluded all other types of cancers (GIST, serous tumors …). We assessed the time between the beginning of the symptoms and the beginning of the treatment and the number of patients that were diagnosed at the complication stage. We also assessed the staging of the tumor at the moment of diagnosis and the complete surgical resection rate. Results: Among the 165 patients admitted for digestive cancer, 54,9% were males with a sex ratio of 1,22 M/F. The average age of our patients was 62,8 years varying between 25 and 86 years old and with a standard deviation of 11,8 years. Digestive cancers were diagnosed in 79 patients during period 1, 43 patients during period2, and 43 during period 3. We found a statistically significant increase in the percentage of patients with advanced cancer by 21,7% (p = 0,045) from 2019 to 2020. The delay in diagnosis (p = 0,275), percentage of cancer discovered at the stage of complication(p = 0,728), and the reduction in complete surgical resection (p = 0,177) were not statistically significant. Conclusion: Our results show an undeniable impact of the COVID-19 pandemic on the staging of digestive cancers but the impact on their care remains to be proven and needs a long-term survival follow-up.

Effect of lockdown on digestive system cancer care amongst older patients during the first wave of COVID-19: The CADIGCOVAGE multicentre cohort study.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has had a dramatic impact on cancer diagnosis and treatment. Most patients newly diagnosed with digestive system cancer are aged 65 and over. METHODS: We performed a retrospective, observational, multicentre cohort study based on prospectively collected electronic health records. All adults aged 65 or over and having been newly treated for a digestive system cancer between January 2018 until August 2020 were enroled. RESULTS: Data on 7882 patients were analysed. The first COVID-19 lockdown period led to a 42.4% decrease in newly treated digestive system cancers, and the post-lockdown period was associated with a 17% decrease. The decrease in newly treated digestive system cancer did not differ as a function of age, sex, comorbidities, primary tumour site, and disease stage. The proportion of patients admitted to an emergency department increased during the lockdown period. We do not observe a higher 3-month mortality rate in 2020, relative to the corresponding calendar periods in 2018 and 2019. CONCLUSION: To avoid a decrease in newly treated cancers during future lockdown periods, access to healthcare will have to be modified. Although 3-month mortality did not increase in any of the patient subgroups, the 2020 cohort must be followed up for long-term mortality.

Digestive Oncology in the COVID-19 Pandemic Era.

INTRODUCTION: Since the rise of the COVID-19 pandemic there has been widespread concern regarding the possible delay in the diagnosis/treatment of cancer patients. We aimed to assess the impact of the COVID-19 pandemic on the diagnosis, treatment, and outcome of patients with digestive cancer. METHODS: This was a retrospective study including patients with an inaugural digestive cancer diagnosis discussed for the first time at our center during the weekly digestive oncology reunion (DOR) meeting. The study group was enlisted from March to August 2020, and a control group was sourced from the equivalent period of 2018. Patients with a previous digestive cancer diagnosis/discussion in the DOR were excluded. The following data were collected: demographics, referral origin, tumor staging, first DOR discussion timing, treatment, and outcome. RESULTS: A total of 235 patients were included: 107 in the study group (65.4% male, mean age 71.59 years); 128 in the control group (54.7% male, mean age 68.16 years). The mean number of clinical discussions per week was higher in 2018 (13.65 vs. 10.67, p = 0.040), without a difference in the mean number of patients discussed for the first time (inaugural diagnosis) between groups (p = 0.670). In the 2020 study group, more patients were referred to DOR from the emergency room (ER), fewer from the outpatient clinic/hospital wards (p < 0.001), and more were referred after urgent surgery (p = 0.022). There was no difference in the mean waiting time from diagnosis to first DOR discussion (p = 0.087). Tumor staging in colorectal, gastric, and esophageal cancer was not significantly different between the groups (p = 0897, p = 0.168, and p = 0.717). More patients in the study group presented with stage IV pancreatic cancer (p = 0.043). There was no difference in the time span from DOR until the beginning of neoadjuvant chemotherapy (p = 0.680) or elective surgery (p = 0.198), or from surgery until adjuvant chemotherapy (p = 0.396). Also, there was no difference in 30-day mortality from the first DOR date between the groups (p = 0.742). CONCLUSION: During the COVID-19 era there was a reduced number of clinical discussions in the DOR, but the number of debated patients with an inaugural digestive cancer diagnosis was similar. In the study group more patients were referred to DOR from the ER, and were referred after urgent surgery, suggesting a delayed demand for clinical attention. Study group patients were not significantly affected by the pandemic regarding timely DOR discussion, beginning of treatment, or 30-day mortality, reflecting the maintenance of the quality of care for digestive cancer patients.

INTRODUÇÃO: Desde o início da pandemia por COVID-19, desenvolveu-se a preocupação com o possível atraso no diagnóstico/tratamento dos doentes oncológicos. O nosso objetivo foi avaliar o impacto da pandemia no diagnóstico, tratamento e prognóstico dos doentes com cancro digestivo. MÉTODOS: Estudo retrospetivo, incluindo doentes com diagnóstico inaugural de cancro digestivo, discutidos pela primeira vez na reunião semanal de oncologia digestiva (ROD) do nosso hospital, de Março-Agosto 2020 (grupo de estudo) e do período equivalente de 2018 (grupo controlo). Excluídos doentes com diagnóstico prévio de cancro digestivo/discussão prévia na ROD. Colheram-se: dados demográficos, origem da referenciação, estadio tumoral ao diagnóstico, data da primeira discussão na ROD, tratamento e prognóstico. RESULTADOS: Incluídos 235 doentes, 107 no grupo de estudo (65.4% homens, idade média 71.59), 128 no grupo controlo (54.7% homens, idade média 68.16). Número médio de discussões clínicas semanais na ROD foi superior em 2018 (13.65 vs. 10.67, p = 0.040). Sem diferença estatisticamente significativa no número de doentes discutidos pela primeira vez na ROD (diagnóstico inaugural) entre os grupos (p = 0.670). Mais doentes referenciados à ROD do Serviço de Urgência (SU) em 2020, menos a partir do ambulatório/ enfermaria (p < 0.001) e mais doentes referenciados após cirurgia urgente em 2020 (p = 0.022). Sem diferença entre os dois grupos no tempo médio de espera desde diagnóstico até a primeira discussão na ROD (p = 0.087). O estadio tumoral do cancro colorretal, gástrico e esofágico não foi significativamente diferente nos dois grupos (p = 0897, p = 0.168 e p = 0.717). Mais doentes apresentaram cancro pancreático em estadio IV no grupo de estudo (p = 0.043). Sem diferença no tempo desde ROD até início de quimioterapia neoadjuvante (p = 0.680) ou cirurgia eletiva (p = 0.198), nem da cirurgia até quimioterapia adjuvante (p = 0.396). Sem diferença na mortalidade aos 30 dias após primeira discussão na ROD nos dois grupos (p = 0.742). CONCLUSÃO: Durante a pandemia, o número de discussões clínicas na ROD foi inferior, mas o número de doentes com diagnóstico inaugural de cancro digestivo foi semelhante. No grupo de estudo, mais doentes foram referenciados à ROD do SU e mais após cirurgia urgente, sugerindo maior demora dos doentes para procurar atenção médica. Em 2020, os doentes não foram significativamente afetados pela pandemia relativamente à discussão atempada na ROD, início de tratamento ou mortalidade aos 30 dias, refletindo a manutenção da qualidade do suporte clínico aos doentes com cancro digestivo.

Management of digestive cancers during the COVID-19 second wave: A French intergroup point of view (SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO, ACHBT, SFR).

INTRODUCTION: The COVID-19 pandemic has major impact of healthcare systems, including cancer care pathways. The aim of this work is to discuss in a multidisciplinary approach the therapeutic and/or strategies adaptations for patients treated for a digestive cancer during the European second wave of COVID-19 pandemic. METHODS: A collaborative work was performed by several French societies to answer how to preserve digestive cancer care with no loss of chance during the second wave of COVID-19. In this context, all recommendations are graded as expert's agreement according to level evidence found in literature until October 2020 and the experience of the first wave of the COVID-19 pandemic. RESULTS: As far as possible, no therapeutic modification should be carried out. If necessary, therapeutic adjustments may be considered if they do not constitute a loss of chance for patients. Considering the level of evidence all therapeutic modifications need to be discussed in multidisciplinary tumor board meeting and with patient consent. By contrast to first wave cancer prevention, cancer screening, supportive care and clinical trials should be continued. CONCLUSION: Recommendations proposed could limit cancer excess mortality due to the COVID-19 pandemic but should be adapted according to the situation in each hospital.