Assessing the impact of COVID-19 on liver cancer management (CERO-19)

JHEP Rep. 2021 Jun;3(3):100260. doi: 10.1016/j.jhepr.2021.100260. Epub 2021 Feb 23.


Background & aims: The coronavirus disease 2019 (COVID-19) pandemic has posed unprecedented challenges to healthcare systems and it may have heavily impacted patients with liver cancer (LC). Herein, we evaluated whether the schedule of LC screening or procedures has been interrupted or delayed because of the COVID-19 pandemic.

Methods: An international survey evaluated the impact of the COVID-19 pandemic on clinical practice and clinical trials from March 2020 to June 2020, as the first phase of a multicentre, international, and observational project. The focus was on patients with hepatocellular carcinoma or intrahepatic cholangiocarcinoma, cared for around the world during the first COVID-19 pandemic wave.

Results: Ninety-one centres expressed interest to participate and 76 were included in the analysis, from Europe, South America, North America, Asia, and Africa (73.7%, 17.1%, 5.3%, 2.6%, and 1.3% per continent, respectively). Eighty-seven percent of the centres modified their clinical practice: 40.8% the diagnostic procedures, 80.9% the screening programme, 50% cancelled curative and/or palliative treatments for LC, and 41.7% modified the liver transplantation programme. Forty-five out of 69 (65.2%) centres in which clinical trials were running modified their treatments in that setting, but 58.1% were able to recruit new patients. The phone call service was modified in 51.4% of centres which had this service before the COVID-19 pandemic (n = 19/37).

Conclusions: The first wave of the COVID-19 pandemic had a tremendous impact on the routine care of patients with liver cancer. Modifications in screening, diagnostic, and treatment algorithms may have significantly impaired the outcome of patients. Ongoing data collection and future analyses will report the benefits and disadvantages of the strategies implemented, aiding future decision-making.

Lay summary: The coronavirus disease 2019 (COVID-19) pandemic has posed unprecedented challenges to healthcare systems globally. Herein, we assessed the impact of the first wave pandemic on patients with liver cancer and found that routine care for these patients has been majorly disrupted, which could have a significant impact on outcomes.

Keywords: BCLC, Barcelona Clinic Liver Cancer; CERO-19, Liver Cancer Outcome in the COVID-19-pandemic Project; COVID-19; COVID-19, coronavirus disease 2019; Cholangiocarcinoma; Clinical trials; ENS-CCA, European Network for the Study of Cholangiocarcinoma; HCC, hepatocellular carcinoma; Hepatocellular carcinoma; LC, liver cancer; LT, liver transplantation; Liver cancer; Management; Nurses; SARS-CoV-2, severe acute respiratory syndrome coronavirus-2; iCCA, intrahepatic cholangiocarcinoma.