Care delivery impact of the COVID-19 pandemic on anal cancer care

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.