Changes in lung cancer staging and emergency presentations during the first year of the COVID-19 pandemic.
Claire VellaWadood ParvezAsif AshrafSyed AjmalRajini SudhirSanjay AgrawalJonathan BennettMuhammad TufailPublished in: Chronic respiratory disease (2023)
Aim : This study retrospectively analyses the impact of the 1 st year of the COVID-19 pandemic on route of presentation and staging in lung cancer compared to the 2 years before and after implementation of the Leicester Optimal Lung Cancer Pathway (LOLCP) in Leicester, United Kingdom. Method : Electronic databases and hospital records were used to identify all patients diagnosed with lung cancer in 2018 (pre-LOLCP), 2019 (post-LOLCP), and March 2020-2021 (post-COVID-19 lockdown). Information regarding patient characteristics, performance status, stage, and route of diagnosis was documented and analysed. Emergency presentation was defined as diagnosis of new lung cancer being made after unscheduled attendance to urgent or emergency care facility. Results : Following implementation of the LOLCP pathway, there was a significant decrease in emergency presentations from 26.8 to 19.6% ( p = 0.002) with a stage shift from 33.9% early stage disease to 40.3%. These improved outcomes were annulled during the COVID-19 pandemic, with emergency presentations increasing to 38.9% ( p < 0.001) and a reduction in early-stage lung cancer diagnoses to 31.5%. There was a 61% decline in 2 week wait referrals but no significant decline in the LOLCP direct-to-CT referrals. Conclusion : We have demonstrated a significant increase in late-stage lung cancer diagnoses and emergency presentations during the first year of the COVID-19 pandemic. The causes for these changes are likely to be multifactorial. The long-term effect on lung cancer mortality remains to be seen and is an important focus of future study.
Keyphrases
- healthcare
- public health
- emergency department
- early stage
- primary care
- lymph node
- quality improvement
- type diabetes
- end stage renal disease
- magnetic resonance imaging
- cardiovascular disease
- coronary artery disease
- chronic kidney disease
- squamous cell carcinoma
- newly diagnosed
- randomized controlled trial
- skeletal muscle
- palliative care
- clinical trial
- metabolic syndrome
- weight loss
- neoadjuvant chemotherapy
- radiation therapy
- peritoneal dialysis
- deep learning
- social media
- sentinel lymph node
- positron emission tomography
- big data
- respiratory syndrome coronavirus