The impact of covid-19 on patients presenting with lung cancer-the missing fifth

ABSTRACT

Background The Coronavirus Disease-19 (COVID-19) pandemic continues to cause significant disruption worldwide. Within the UK there were considerable adjustments in all healthcare settings to ensure appropriate management of patients affected by COVID-19, with consequent disruption to existing services. Lung cancer is associated with a high mortality rate, not least because there are often delays in diagnosis. We examined referrals before and during the COVID-19 pandemic to determine whether this affected the number of patients seen and the speed to diagnosis. Methods We compared referrals to our Lung Cancer Service during the four months prior to and immediately following the onset of the UK COVID-19 pandemic in March 2020. We collected data relating to the numbers and origins of referrals, as well as the time intervals at different stages of our diagnostic pathway. Results Our service received fewer referrals following the onset of the pandemic, with a mean of 97 patients per month from November 2019 to February 2020, compared to 79 patients per month between March and June 2020. Urgent cancer referrals from General Practitioners ('twoweek-wait') were reduced (50% to 44%) during the pandemic. A greater proportion of patients presented via alternative pathways, including A&E, suggesting a later presentation. The gender of patients referred remained similar between both timeframes, although during the COVID-19 pandemic, the mode average age was slightly younger at 73 years (79 years previously), with an age range 29-97 years (21-93 years pre-COVID-19). After receiving a referral, the time to first review remained stable (98% vs 99%). The mean time from referral to diagnosis remained 14 days. 91% of patients received a lung cancer diagnosis within 28 days of referral, despite the COVID-19 pandemic (94% previously). Conclusion Time to lung cancer diagnosis was not affected by changes to our clinical service during the COVID-19 pandemic. However, there was a significant reduction in the overall number of referrals (almost one fifth). We will monitor to review whether there is an increase in late presentations in the coming months due to delays in referral. The fear is that future increases in COVID-19 cases nationally will further delay these patients presenting.