Impact of COVID-19 on cancer services and patients' outcomes: a retrospective single-center study

Baijaeek Sain; Arnab Gupta; Aruni Ghose; Sudip Halder; Samir Bhattacharya; Radha Raman Mondal; Subhamoy Paul; Chandrakanth Are; Stergios Boussios

doi:10.21037/atm-22-5876

Impact of COVID-19 on cancer services and patients' outcomes: a retrospective single-center study

Ann Transl Med. 2023 Jun 30;11(9):310. doi: 10.21037/atm-22-5876. Epub 2023 Jun 15.

Authors

Baijaeek Sain^{1

2}, Arnab Gupta², Aruni Ghose^{3

4

5}, Sudip Halder², Samir Bhattacharya², Radha Raman Mondal², Subhamoy Paul⁶, Chandrakanth Are⁷, Stergios Boussios^{5

8

9

10}

Affiliations

¹ Department of Trauma & Orthopaedics, Imperial College London Healthcare NHS Trust, London, UK.
² Department of Surgical Oncology, Saroj Gupta Cancer Centre and Research Institute, Kolkata, India.
³ Department of Medical Oncology, Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, London, UK.
⁴ Department of Medical Oncology, Barts Cancer Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
⁵ Department of Medical Oncology, Medway NHS Foundation Trust, Gillingham, Kent, UK.
⁶ Department of Critical Care, Saroj Gupta Cancer Centre and Research Institute, Kolkata, India.
⁷ Department of Surgical Oncology, University of Nebraska Medical Centre, Omaha, NE, USA.
⁸ Faculty of Life Sciences & Medicine, School of Cancer & Pharmaceutical Sciences, King's College London, London, UK.
⁹ Kent Medway Medical School, University of Kent, Canterbury, UK.
¹⁰ AELIA Organization, 9th Km Thessaloniki-Thermi, Thessaloniki, Greece.

Abstract

Background: Our main objective was to assess the impact of the coronavirus disease 2019 (COVID-19) on cancer services and cancer patients in terms of disease severity, morbidity and mortality. Secondary objectives were to characterize cancer type, affected age groups, gender, comorbidities, infectivity, and to identify cancer treatment delay and its complications after COVID-19 infection.

Methods: A retrospective analysis of electronic health records of polymerase chain reaction (PCR)-confirmed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infected cancer patients from April 2020 to March 2021 was done. The following parameters were investigated upon-new and follow-up cases during the pandemic and its preceding years (2018-2019, 2019-2020), age, sex, type of cancer, comorbidities, presentation, symptomatology and treatment for COVID-19, time to recovery, complications, delay in treatment and survival outcome. Statistical analysis using chi-square testing was done on the above variables.

Results: There was a 50.49% reduction in the number of new and follow-up cases as compared to that of the previous years. Seventy-four out of 310 (23.87%) COVID-19 positive cancer patients were aged in their sixth decade with the commonest type being hematological malignancies. A proportion of 84.8% (n=263) patients were asymptomatic. Univariate analysis was statistically significant for mortality with regard to age ≥60 years (P=0.034), type of malignancy (P=0.000178), hypertension (P=0.0028), symptomatology of COVID-19 infection (P=0.0016), site of treatment and oxygen/intervention (P<0.0001). There was an average delay in treatment time of 5 to 6 weeks. Multivariate analysis showed that gastrointestinal (GI) and hepato-pancreato-biliary (HPB) malignancies and oxygen requirement (>2 L/min) were responsible for the 20.65% mortality rate.

Conclusions: The pandemic significantly affected the care of cancer patients with decreased cases, late presentation, delayed treatment with potentially worse mortality outcome. Although they have decreased immunity, majority were asymptomatic. Most of the fatalities were in the GI and HPB malignancies.

Keywords: Coronavirus disease 2019 (COVID-19); cancer; comorbidities; morbidity; mortality.