COVID affects cancer treatment, patient’s mental health

According to a retrospective cohort study in Spain, the diagnosis of lung cancer declined and the outcome worsened during the first six months of 2020. This is consistent with the COVID-19 pandemic.

From January to June 2020, the number of new lung cancer cases decreased by 38% compared to the same period last year. The 30-day mortality rate almost doubled, and the median overall survival (OS) decreased by more than a month.

“Lung cancer diagnosis is affected during COVID,” said Dr. Roxana Reyes of the Barcelona Hospital Clinic. World Congress on Lung Cancer (WCLC) Virtual conference. “In non-small cell lung cancer [NSCLC]I noticed a more symptomatological and more severe case diagnosed during COVID. 30-day mortality increased and poor outcomes were observed. “

“The COVID-19 pandemic is likely to last for a long time, so special efforts must be made to ensure the diagnosis of cancer and the treatment of patients.”

The presentation was included in a WCLC press conference focusing on the impact of COVID-19 on lung cancer treatment, including patient-related results.

Consistent data

Reyes’ study continued the narration that appeared early in the COVID-19 pandemic: reduced attention to cancer screening, reduced time for non-essential care, and tense medical care to deal with the pandemic. Redistribute resources. A retrospective analysis investigated the impact of a pandemic on diagnosis and outcomes at two tertiary hospitals, but may reflect experience at centers around the world.

“Cancer patients are very vulnerable,” Reyes said. “They are on the rise in severity and mortality. Lung cancer patients are a particularly high-risk population. In Spain, the first and second waves of the pandemic cause emergencies and prioritize medical services. It can cause and delay diagnosis. Treatment of cancer patients. Our aim was to study the incidence, severity, and outcome of lung cancer in COVID. “

Investigators compared data on thoracic malignancies from January to June 2019 (before COVID) and 2020 (during a pandemic). They investigated differences in the number of new lung cancer cases, disease severity (defined by performance status, stage, or the presence of significant complications at diagnosis), and 30-day mortality.

During the first six months of 2019, clinicians diagnosed 100 new cases of lung cancer. One year later, the total number of cases decreased to 62. Histological distribution did not change (68% NSCLC and 32% small cell lung cancer) [SCLC]). Patients during the two periods had a similar history (8% vs. 16%), except for nonsmokers whose proportion doubled during the pandemic. Age, gender distribution, and performance status at diagnosis were similar.

Focusing on patients with NSCLC, Reyes said the number of new diagnoses decreased from 13 to 9 (36%) per month. Diseases during a pandemic, including emergencies (3% vs. 7%), hospitalization (18% vs. 21%), inpatient deaths (17% vs. 44%), and progressive diseases at diagnosis (46% vs. 58%) The severity of the disease has increased. From two metastatic sites (12% vs 16%) and symptomatological disorders (63% vs 74%).

The number of SCLC diagnoses decreased by 42% during the pandemic. However, in reality, all the parameters that define the severity reduced the severity of the disease.

Lung cancer-related mortality increased during the pandemic, Reyes said. The 30-day mortality rate increased from 25% before the pandemic to 49% in NSCLC patients and from 18% in SCLC to 32%. The median overall survival was 7.9 months in 2019 and 6.7 months in 2020.

Psychological effects

As Dr. Domenico Galetta of the Giovanni Paolo II Cancer Institute in Bari, Italy stated, the pandemic exacerbated the patient’s psychological distress beyond the impact of COVID-19 on cancer treatment. ..

Population-based studies have reported an increased incidence of anxiety, depression, and post-traumatic stress disorders during pandemics. However, the psychological effects on cancer patients have not been extensively studied, Garetta said. He reported findings from a study of 176 patients from an outpatient oncology clinic. The cohort consisted of 77 patients with lymphoma, 59 with lung cancer, and 40 with breast cancer.

Each patient completed a series of questionnaires to assess their psychological state. Hospital Anxiety and Depression Scale (HADS). Event Scale Impact-Revised (IES-r); A simple structured questionnaire about concerns.

HADS results showed that 55% of patients reported general distress, 44.5% reported depression, and 58% reported anxiety. Although the rates were similar in men and women, patients with lung cancer had higher scores for all parameters assessed by HADS than patients with lymphoma or breast cancer. IES-r data showed that a quarter of patients had high levels of stress and were reported more frequently by women (27.3% vs. 18.4%,). P<0.05).

Men and women had similarly high levels of concern, but women had infections during hospital visits (60% vs. 40%), treatment delays (62% vs. 38%), and contact with an oncologist. More concerned about potential difficulties (66%) vs. 34%). Men were more worried about financial problems (57% vs. 43%).

“Protecting cancer patients is an important element of public health measures to combat the COVID-19 epidemic,” said Garetta. “Special interventions to promote the mental health of patients during this time of the coronavirus pandemic need to be implemented as soon as possible, especially for women and lung cancer patients.”

Another study of 302 lung cancer patients interviewed after shelter-in-place restrictions showed that 96% were concerned about discontinuing cancer treatment during a pandemic. Almost half reported discontinuation of cancer treatment, 18% said they were having difficulty getting proper treatment, and 45% were worried about receiving post-pandemic treatment.

“Our study shows that patients with lung cancer continue to feel vulnerable and inadequate to navigate post-shelter-in-place cancer treatment,” said Jessica Serig of the LUNGevity Foundation in Chicago. Stated. “Certainly, patient-specific factors (treatment status) and the number of local COVID-19 cases are important predictors of patient concern. Access to care is at the patient-doctor discussion and system level. It should be taken into account in both lung cancer treatment plans. “