TOPIC: Lung Cancer
TYPE: Original Investigations
PURPOSE: The COVID-19 pandemic led to the prioritization of acute care and the shift from preventative medicine to caring for the millions of patients infected with the SARS-CoV-2 virus. There was a shift away from routine incidental pulmonary nodule follow-up due to increased potential exposure. We hypothesize that this temporary lapse in the practice of routine incidental lung nodule follow-up may lead to delays in the time to diagnosis and treatment of intrathoracic malignancy.
METHODS: We conducted a single institution, case-control study evaluating patients seen at our pulmonary nodule clinic (PNC) prior to and during the COVID pandemic. Outcomes of interest included time to diagnosis, and time to treatment. Data for both cohorts was collected for 12 months (3/2019-2/2020; 3/2020-3/2021 respectively). All patients seen in PNC who were diagnosed with cancer after initial evaluation were included. Nonparametric testing was used to compare median time to diagnosis and time to treatment pre and during the pandemic.
RESULTS: A total of 36 patients were included in the pre-pandemic cohort with a mean age of 69.9 ± 6.64, and 19 patients were included in the pandemic cohort, with a mean age of 70.1 ±10. Prior to the pandemic the median time to diagnosis was longer compared to during the pandemic (26.5 vs 18 days). Additionally, the median time to treatment pre-pandemic was longer compared to during the pandemic (77.5 vs. 57 days). Despite the difference in days to diagnosis and days to treatment between the two cohorts neither met statistical significance. Of note, there was almost a 50% decrease in the number of patients diagnosed with lung cancer during the pandemic.
CONCLUSIONS: During this unprecedented global pandemic, the primary emphasis on preventative services has lessened. We evaluated outcomes at our PNC and found that there were no statistically significant differences in time to diagnosis or treatment of intrathoracic cancer in patients seen prior to and during the pandemic. However, we believe that there is clinical significance to our conclusion. The decreased incidence of patients diagnosed during the pandemic may reflect immortal time bias or clinically inapparent fear of infection leading to hesitancy to be evaluated on the patients’ part. It is possible that the fewer number of patients screened during the pandemic has led to expeditious evaluation and treatment.
CLINICAL IMPLICATIONS: As the healthcare system attempts to return to pre-pandemic functionality, there may be an increased incidence of lung cancer, reflecting missed diagnoses during the pandemic. Timely evaluation and structured follow-up are paramount to improving outcomes in lung cancer patients and for achieving pre-pandemic standards of care.
DISCLOSURES: No relevant relationships by Hatoon Abbas, source=Web Response
No relevant relationships by Fahid Alghanim, source=Web Response
No relevant relationships by Janaki Deepak, source=Web Response
No relevant relationships by William Grier, source=Web Response
No relevant relationships by Avelino Verceles, source=Web Response