The Impact of COVID-19 on the Diagnosis and Treatment of Lung Cancer over a 2-Year Period at a Canadian Academic Center
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population
- Cohort #1: Pre-COVID-19 (1 March 2019–29 February 2020);
- Cohort #2: 1st year of COVID-19 (1 March 2020–28 February 2021);
- Cohort #3: 2nd year of COVID-19 (1 March 2021–28 February 2022).
2.2. The Primary Objective
2.3. Secondary Objectives
- To characterize treatment pattern changes in lung cancer during the COVID-19 pandemic;
- To evaluate the wait times before and during the COVID-19 era.
2.4. Data Collection
- Demographics: age, sex, smoking history;
- Disease characteristics: stage, histopathological diagnosis, molecular testing results;
- Treatment history: referral date, type of first definitive treatment (FDT), start and end date of treatment;
- Diagnosis timing: referral date, date of first lung specialist consult, date of diagnosis;
- Survival data (to be reported later).
2.5. Definitions of Wait Times
2.6. Statistical Analysis
3. Results
3.1. Study Population
3.2. New Diagnosis of Lung Cancer
3.3. Treatment Pattern
3.4. Wait Times
3.5. Molecular Testing
4. Discussion
5. Limitations
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Wait Time | Mean Time (Days) | Guidelines |
---|---|---|
Referral → Lung cancer specialist | 14 | National Health Service [10] |
Referral → Diagnosis | 30 | British Thoracic Society [8] |
Referral → FDT 1 | 62 | National Health Service |
Diagnosis → FTD | 30 | British Thoracic Society |
DTT 2 → FTD | 31 | British Thoracic Society |
Diagnosis → First chemotherapy | 28 | British Thoracic Society |
Surgery consult → Surgery | 28 | British Thoracic Society |
Radiation consult → First radiation therapy | 42 | RAND Corporation [9] |
Characteristics | 2019 n = 130 | 2020 n = 103 | 2021 n = 184 | |
---|---|---|---|---|
Age (mean; range) | 70 (40–96) | 71 (42–92) | 71 (41–92) | |
Sex (male/female) | 73/57 | 56/47 | 88/96 | |
Cancer stage (n/%) | Early stage (T1–3N0–1M0) Early stage (T1–3N0–1M0) Locoregional (T1–4N2–3M0) Advanced/metastatic stage (TanyNanyM1) | 42 (32) | 33 (35) | 55 (30) |
Locoregional (T1–4N2–3M0) | 20 (15) | 11 (10) | 29 (15) | |
Advanced/metastatic stage (TanyNanyM1) | 68 (53) | 59 (55) | 100 (55) | |
Smoking history (n/%) | Former/current smoker Non-smoker | 99 (76) | 74 (74) | 156 (85) |
Non-smoker | 31 (24) | 29 (26) | 28 (15) | |
Treatment type: (n/%) | FDT 1 | 110 (85)) | 84 (82) | 151 (84) |
PT 2 | 20 (15) | 19 (18) | 33 (16) |
Variables | 2019 | 2020 | 2021 |
---|---|---|---|
Number of new diagnoses treated | 130 | 103 | 184 |
Average per month | 11 | 9 | 15 |
Change in volume of new diagnoses compared to 2019 a | −21% | +41% | |
Change in volume of new diagnoses compared to 2020 b | +79% |
M Status | 2019 n = 68 | 2020 n = 59 | 2021 n = 100 | |
---|---|---|---|---|
M1a n (%) | Pericardial/pleural effusion or contralateral lung | 20 (29) | 14 (24) | 31 (31) |
M1b n (%) | Single extrathoracic site | 27 (40) | 11 (19) | 18 (18) |
M1c n (%) | Multiple extrathoracic sites | 21 (31) | 34 (57) | 51 (51) |
The two-tailed p value | 2020 vs. 2019 | 0.002 | ||
The two-tailed p value | 2021 vs. 2019 | 0.013 |
Type of FTD | 2019 n = 110 | 2020 n = 84 | 2021 n = 151 | p-Value | |
---|---|---|---|---|---|
Surgery (n/%) | 42 (38) | 24 (25) | 54 (36) | 0.01 | |
Radiosurgery (n/%) | 8 (7) | 20 (21) | 12 (8) | 0.009 | |
Chemotherapy (n/%) | Total | 60 (54) | 40 (47) | 85 (56) | >0.05 |
Standard systemic chemotherapy | 21 (35) | 12 (30) | 25 (29) | ||
Immunotherapy ± chemotherapy | 23 (37) | 16 (40) | 37 (44) | ||
Targeted therapy | 17 (28) | 12 (30) | 23 (27) |
Interval (Days) | 2019 n = 130 | 2020 n =103 | 2021 n = 184 | p-Value | |||
---|---|---|---|---|---|---|---|
n | Mean (SD 1) | n | Mean (SD 1) | n | Mean (SD 1) | ||
Referral → Lung cancer specialist (14) | 130 | 12 (14) | 103 | 11 (13) | 184 | 10 (11) | 0.67 |
Referral → Diagnosis (30) | 130 | 59 (51) | 103 | 59 (67) | 184 | 65 (94) | 0.94 |
Wait for the path report (14) | 130 | 8 (7.3) | 103 | 10 (12) | 184 | 8 (9) | 0.98 |
Decision-to-treat to FDT 2 (31) | 130 | 52 (48) | 103 | 51 (61) | 151 | 43 (51) | 0.94 |
Diagnosis to chemotherapy (28) | 60 | 38 (25) | 40 | 34 (24) | 85 | 43 (33) | 0.95 |
Diagnosis to RT 3 (42) | 24 | 35 (30) | 38 | 46 (33) | 49 | 40 (53) | 0.31 |
Surgical consult to surgery (28) | 42 | 64 (43) | 24 | 76 (83) | 54 | 77 (62) | 0.04 |
Wait for molecular test results (7) | 142 | 22 (10) | 102 | 16 (9) | 218 | 26 (12) | 0.90 |
Interval (Days) | 2019 | 2020 | 2021 | p-Value |
---|---|---|---|---|
Proportion (%) | ||||
Referral → Lung cancer specialist (14) | 90/130 (69) | 74/103 (72) | 123/184 (67) | 0.35 |
Referral → Diagnosis (30) | 52/130 (40) | 50/103 (48) | 82/184 (45) | 0.15 |
Referral → FDT (62) | 55/110 (51) | 49/84 (58) | 91/151 (60) | 0.29 |
Diagnosis → First systemic therapy 1 (28) | 24/60 (37) | 17/40 (42) | 34/85 (40) | 0.45 |
Diagnosis → First targeted therapy (28) | 11/17 (65) | 5/12 (42) | 13/23 (57) | 0.43 |
Surgical consult → Surgery (28) | 6/42 (14) | 8/24 (30) | 12/54 (22) | 0.12 |
RadOnc 2 consult → Radiation treatment (42) | 17/24 (71) | 30/38 (79) | 35/48 (73) | 0.52 |
Test | 2019 n = 130 | 2020 n = 103 | 2021 n = 184 | p-Value | |||
---|---|---|---|---|---|---|---|
n | Mean (SD 1) Days | n | Mean (SD 1) Days | n | Mean (SD 1) Days | ||
NGS 2 | 66 | 15 (6) | 62 | 18 (9) | 117 | 31 (10 | 0.03 |
ctDNA | 58 | 6 (10) | 32 | 10 (18) | 179 | 16 (17) | 0.05 |
NanoString | 18 | 25 (11) | 27 | 27 (18) | 22 | 30 (12) | 0.50 |
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Kasymjanova, G.; Rizzolo, A.; Pepe, C.; Friedmann, J.E.; Small, D.; Spicer, J.; Lecavalier-Barsoum, M.; Sultanem, K.; Wang, H.; Spatz, A.; et al. The Impact of COVID-19 on the Diagnosis and Treatment of Lung Cancer over a 2-Year Period at a Canadian Academic Center. Curr. Oncol. 2022, 29, 8677-8685. https://doi.org/10.3390/curroncol29110684
Kasymjanova G, Rizzolo A, Pepe C, Friedmann JE, Small D, Spicer J, Lecavalier-Barsoum M, Sultanem K, Wang H, Spatz A, et al. The Impact of COVID-19 on the Diagnosis and Treatment of Lung Cancer over a 2-Year Period at a Canadian Academic Center. Current Oncology. 2022; 29(11):8677-8685. https://doi.org/10.3390/curroncol29110684
Chicago/Turabian StyleKasymjanova, Goulnar, Angelo Rizzolo, Carmela Pepe, Jennifer E. Friedmann, David Small, Jonathan Spicer, Magali Lecavalier-Barsoum, Khalil Sultanem, Hangjun Wang, Alan Spatz, and et al. 2022. "The Impact of COVID-19 on the Diagnosis and Treatment of Lung Cancer over a 2-Year Period at a Canadian Academic Center" Current Oncology 29, no. 11: 8677-8685. https://doi.org/10.3390/curroncol29110684
APA StyleKasymjanova, G., Rizzolo, A., Pepe, C., Friedmann, J. E., Small, D., Spicer, J., Lecavalier-Barsoum, M., Sultanem, K., Wang, H., Spatz, A., Cohen, V., & Agulnik, J. S. (2022). The Impact of COVID-19 on the Diagnosis and Treatment of Lung Cancer over a 2-Year Period at a Canadian Academic Center. Current Oncology, 29(11), 8677-8685. https://doi.org/10.3390/curroncol29110684