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Shift in Lung Cancer Stage at Diagnosis during the COVID-19 Pandemic in New York City
Journal of Thoracic Oncology ; 17(9):S240, 2022.
Article in English | EMBASE | ID: covidwho-2031516
ABSTRACT

Introduction:

New York City was the first place in the US to record a COVID-19 case on March 1, 2020, and soon became the epicenter of the pandemic. Because of the large number of hospitalized patients, Governor Cuomo imposed a halt on all elective care from March 22 to June 8, 2020. Such action resulted in delayed cancer screening rates, care and treatment. However, no study has quantified the effect of the “pause” on cancer stage at diagnosis, one of the best indicators of cancer prognosis. We analyze here data from the Mount Sinai Heath System cancer registry;we chose lung cancer as an example of a condition where early diagnosis can dramatically modify survival.

Methods:

Lung cancer cases diagnosed between January 1, 2018 and February 28, 2021 (n=1884) at the Mount Sinai Health System were identified from Mount Sinai’s cancer registry, based on ICD-10 codes of C34.x. Only analytic cases (00-22) were included, based on Commission on Cancer guidelines. For multi-tumor or multi-hospital cases, unique patients were identified by selecting the earliest date of diagnosis. The ratio of the number of monthly cases in 2020-2021 over the average number of monthly cases in 2018 and 2019 was calculated. The percent of monthly diagnoses with early (0/I/II), late (III/IV) and unknown stage over the total number of monthly diagnoses was examined and was compared to the average percent in 2018 and 2019 from the same month.

Results:

The number of diagnoses sharply dropped in March 2020, reaching a minimum in April (78% lower than pre-pandemic averages), and returned to near pre-pandemic levels by July 2020, began to decline again in January and February 2021 (35% lower than pre-pandemic averages) (Figure 1a). Stages 0/I/II dropped to 21.9% of total in May 2020, while stage III/IV hit 75% in April 2020. Early stage diagnoses dropped again to 23.5% of total, while late stages increased to 64.7% of total in February 2021 (Figure 1b). The percent of stage III/IV diagnoses in April of 2020 was 1.79 times greater than the pre-pandemic average, the percent of stage 0/I/II diagnoses was 50% lower. The percent of stage 0/I/II cases increased between August 2020 and January 2021, but in February 2021 it was 50% lower than pre-pandemic levels, and the percent of stage III/IV diagnoses was 1.3 times greater than pre-pandemic levels (Figure 1c).

Conclusions:

This descriptive analysis suggests an immediate negative impact on lung cancer diagnoses of COVID-19 restrictions, which affected screening, early detection, and drastically reduced any patient’s contact with the health system that would have prompted an early lung cancer diagnosis. The increase in late stage diagnoses during pandemic surges may reflect the fact that only sick patients with symptoms, and acute events that require immediate care were seeking hospital attention. The data suggests that we will likely observe an increase in lung cancer mortality in the next few months and years, as consequence of stage shift at diagnosis associated with the COVID-19 pandemic. Keywords Lung cancer, Covid-19, Stage shift
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Full text: Available Collection: Databases of international organizations Database: EMBASE Language: English Journal: Journal of Thoracic Oncology Year: 2022 Document Type: Article

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Full text: Available Collection: Databases of international organizations Database: EMBASE Language: English Journal: Journal of Thoracic Oncology Year: 2022 Document Type: Article