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The collateral impact of the COVID-19 pandemic on HPV-positive oropharyngeal cancer diagnosis.
Ballal, Yashi; Gete, Maru; Su, Jie; O'Sullivan, Brian; Waldron, John N; Irish, Jonathan; Ringash, Jolie; Kim, John; Bratman, Scott; Cho, John; Hope, Andrew J; Hosni, Ali; de Almeida, John; Goldstein, David P; Witterick, Ian; Monteiro, Eric; Tong, Li; Xu, Wei; Hui Huang, Shao; Hahn, Ezra.
  • Ballal Y; The Michener Institute/University of Toronto, Toronto, Canada; Department of Radiation Therapy, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada. Electronic address: yashi.ballal@mail.utoronto.ca.
  • Gete M; Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada. Electronic address: marugete@gmail.com.
  • Su J; Department of Biostatistics, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada. Electronic address: Susie.Su@uhnresearch.ca.
  • O'Sullivan B; Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada; Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada. Electronic address: Brian.OSullivan@rmp.uhn.ca.
  • Waldron JN; Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada; Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada. Electronic address: John.Waldron@rmp.uhn.ca.
  • Irish J; Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada. Electronic address: Jonathan.Irish@uhn.ca.
  • Ringash J; Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada; Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada. Electronic address: Jolie.Ringash@rmp.uhn.ca.
  • Kim J; Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada. Electronic address: John.Kim@rmp.uhn.ca.
  • Bratman S; Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada. Electronic address: Scott.Bratman@rmp.uhn.ca.
  • Cho J; Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada. Electronic address: John.Cho@rmp.uhn.ca.
  • Hope AJ; Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada. Electronic address: Andrew.Hope@rmp.uhn.ca.
  • Hosni A; Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada. Electronic address: Ali.Hosni@rmp.uhn.ca.
  • de Almeida J; Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada. Electronic address: John.DeAlmeida@uhn.ca.
  • Goldstein DP; Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada. Electronic address: David.Goldstein@uhn.ca.
  • Witterick I; Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada. Electronic address: Ian.Witterick@sinaihealth.ca.
  • Monteiro E; Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada. Electronic address: Eric.Monteiro@sinaihealth.ca.
  • Tong L; Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada. Electronic address: Li.Tong@rmp.uhn.ca.
  • Xu W; Department of Biostatistics, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada. Electronic address: Wei.Xu@uhnresearch.ca.
  • Hui Huang S; Department of Radiation Therapy, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada; Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada; Department of Radiation Oncology, Princess Margaret
  • Hahn E; Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada. Electronic address: Ezra.Hahn@rmp.uhn.ca.
Oral Oncol ; 138: 106332, 2023 03.
Article in English | MEDLINE | ID: covidwho-2221211
ABSTRACT

PURPOSE:

We aim to assess the potential impact of the COVID-19 pandemic on diagnostic delays in HPV-positive oropharyngeal cancer (OPC), and to describe their underlying reasons.

METHODS:

All HPV + OPC referred to a tertiary cancer centre and diagnosed between June-December 2019 (Pre-Pandemic cohort) vs June-December 2020 (Pandemic cohort) were reviewed. TNM classification, gross-tumor-volumes (GTV) and intervals between sign/symptom onset and treatment initiation were compared between the cohorts. Reasons for delay (>6 months from onset of signs/symptoms to a positive biopsy of the primary tumor, or a delay specifically mentioned in the patient chart) in establishing the diagnosis were recorded per clinician's documentation, and categorized as COVID-related or non-COVID-related.

RESULTS:

A total of 157 consecutive HPV + OPC patients were identified (Pre-Pandemic 92; Pandemic 65). Compared to the Pre-Pandemic cohort, Pandemic cohort patients had a higher proportion of N2-N3 (32 % vs 15 %, p = 0.019) and stage III (38 % vs 23 %, p = 0.034) disease at presentation. The differences in proportions with > 6 months delay from symptom onset to establishing the diagnosis (29 % vs 20 %, p = 0.16) or to first treatment (49 % vs 38 %, p = 0.22) were not statistically different. 47 % of diagnostic delays in the Pandemic cohort were potentially attributable to COVID-19.

CONCLUSION:

We observed a collateral impact of the COVID-19 pandemic on HPV + OPC care through more advanced stage at presentation and a non-significant but numerically longer interval to diagnosis. This could adversely impact patient outcomes and future resource allocation. Both COVID-19-related and unrelated factors contribute to diagnostic delays. Tailored interventions to reduce delays are warranted.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Oropharyngeal Neoplasms / Papillomavirus Infections / COVID-19 Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study Topics: Long Covid Limits: Humans Language: English Journal: Oral Oncol Journal subject: Neoplasms Year: 2023 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Oropharyngeal Neoplasms / Papillomavirus Infections / COVID-19 Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study Topics: Long Covid Limits: Humans Language: English Journal: Oral Oncol Journal subject: Neoplasms Year: 2023 Document Type: Article