How the COVID-19 Pandemic Impacted on Integrated Care Pathways for Lung Cancer: The Parallel Experience of a COVID-Spared and a COVID-Dedicated Center

Abstract

Introduction: The COVID-19 pandemic has proved to be a historic challenge for healthcare systems, particularly with regard to cancer patients. So far, very limited data have been presented on the impact on integrated care pathways (ICPs).

Methods: We reviewed the ICPs of lung cancer patients who accessed the Veneto Institute of Oncology (IOV)/University Hospital of Padua (Center 1) and the University Hospital of Verona (Center 2) before and after the COVID-19 pandemic, through sixteen indicators chosen by the members of a multidisciplinary team (MDT).

Results: Two window periods (March and April 2019 and 2020) were chosen for comparison. Endoscopic diagnostic procedures and major resections for early stage NSCLC patients increased at Center 1, where a priority pathway with dedicated personnel was established for cancer patients. A slight decrease was observed at Center 2 which became part of the COVID unit. Personnel shortage and different processing methods of tumor samples determined a slightly longer time for diagnostic pathway completion at both Centers. Personnel protection strategies led to a MDT reshape on a web basis and to a significant selection of cases to be discussed in both Centers. The optimization of patient access to healthcare units reduced first outpatient oncological visits, patient enrollment in clinical trials, and end-of-life cancer systemic treatments; finally, a higher proportion of hypofractionation was delivered as a radiotherapy approach for early stage and locally advanced NSCLC.

Conclusions: Based on the experience of the two Centers, we identified the key steps in ICP that were impacted by the COVID-19 pandemic so as to proactively put in place a robust service provision of thoracic oncology.

Keywords: COVID-19; integrated care pathway; lung cancer; multidisciplinary team discussion; pandemic.

Figure 1

Study design and data collection involving two Centers (Center 1 in Padua; Center 2 in Verona) in the Veneto region, marked here in yellow. The study’s main steps were pursued via telematics, from the study design to data collection and sharing results, in compliance with pandemic containment measures (A). The impact of COVID-19 on lung cancer patient care was assessed through indicators (dashed lines), identified and selected from regional Integrated Care Pathways (ICPs) and from an expert panel on the basis of relevance to healthcare providers’ workloads. The direction of the arrows depicts how these cancer specialists interact with each other in the context of ICPs, while the color of the indicator is the same as that of the healthcare provider whose activity is influenced by (B). MDT, multidisciplinary team.

Figure 2

Pneumology (A), medical oncology (B), thoracic surgery (C), and radiation oncology (D) activity volumes at the two Centers in March and April 2019 compared with March and April 2020. RT, radiotherapy. *Indicates statistically significant differences between 2019 and 2020; p significance level: 0.05.

Figure 3

Median performance time reported in working days and compared between March and April 2019 versus March and April 2020 at the two Centers: (A) Time interval between the pneumology assessment and the first oncological visit; (B) Time interval between the biopsy or surgical procedure and the histological diagnosis, and between the histological diagnosis and molecular results; (C) Time interval between the confirmation of operability based on functional assessment and surgery (lobectomy or pneumonectomy); (D) Number of cases discussed by the multidisciplinary team (MDT) at the two Centers in March and April 2019 compared with March and April 2020. *Indicates statistically significant differences between 2019 and 2020; p significance level: 0.05.