How covid-19 pandemic impacted integrated care pathways for lung cancer: the experience of two Italian centers in veneto region

ABSTRACT

Background: COVID-19 pandemic has represented a historic challenge to healthcare systems. The management of cancer care has become a crucial issue for clinical services to cancer patients. During the COVID-19 pandemic, raising evidence has been published on lung cancer care but no data have been presented on the integrated care pathways (ICP) impact. Materials and methods: We retrospectively reviewed the ICPs of consecutive lung cancer patients who accessed two Centres before and after COVID-19 pandemic the Veneto Institute of Oncology (IOV)/University Hospital of Padua and University Hospital of Verona. Sixteen indicators about oncology, radiaton therapy, thoracic surgery, pathology and pneumology were developed using groupfacilitation techniques taking into account their reproducibility, significance, measurability. We report data extracted from electronic medical records and linked softwares, about MDT performance at the two participating Centres, and preliminary data about pathological and oncological indicators in Padua. Additional data about both complete ICPs will be presented at the Conference. Results: We compared data about ICP performance in two window periods 1/3/2019-30/4/2019 and 1/3/2020- 30/4/2020. MDT meetings were reshaped in order to discuss those cases where more than two specialists were required and whenever possible on a web-basis;therefore, it determined an average reduction of patients discussed of 57.5%. Preliminary data from Padua showed that median time between diagnostic procedure and diagnosis was reduced from 11 days in 2019 to 7.5 days in 2020, mostly due to a prioritization of oncological procedures over any other. Moreover, a 39% reduction of first oncological visits was observed between the two time frames;this was linked to a reduction of out of region second opinion and to optimization of outpatient access. Among patients under oncological treatment, 12(4%) and 8(2%) patients received treatment within 30 days from death in 2019 and 2020, respectively. Conclusions: Based on the experience the two Centres went through, we identified the key steps in ICP impacted by a pandemic such COVID-19 so to proactively put in place robust service provision in thoracic oncology.