Table 1.
Sociodemographic, clinical and treatment characteristics of cancer cases diagnosed and treated before and after the onset of COVID-19 (2 March to 1 July 2019, and 2 March to 1 July 2020, respectively)
| Cancer diagnosis | P value | Proportional variation% (95% CI)a | ||
|---|---|---|---|---|
| Before COVID-19N (%) | After COVID-19N (%) | |||
| 1430 | 866 | −39.4 (−44.3 to −34.1) | ||
| Sex | ||||
| Men | 753 (52.7) | 418 (48.3) | −44.5 (−57.4 to −37.4) | |
| Women | 677 (47.3) | 448 (51.7) | 0.041 | −33.8 (−41.3 to −25.4) |
| Age (years) | ||||
| <55 | 349 (24.4) | 220 (25.4) | −37.0 (−46.7 to −25.4) | |
| 55–64 | 358 (25.0) | 201 (23.2) | −43.9 (−52.8 to −33.3) | |
| 65–74 | 434 (30.3) | 251 (29.0) | −42.2 (−50.5 to −32.4) | |
| >74 | 289 (20.2) | 194 (22.4) | 0.471 | −32.9 (−44.0 to −19.8) |
| Place of residenceb | ||||
| Porto Metropolitan Area | 714 (49.9) | 438 (50.6) | −38.7 (−45.5 to −31.0) | |
| Outside the Porto Metropolitan Area | 716 (50.1) | 428 (49.4) | 0.764 | −40.2 (−47.0 to −62.6) |
| Cancer sitec | ||||
| Esophagus | 27 (1.9) | 18 (2.1) | −33.3 (−62.8 to +21.0) | |
| Stomach | 147 (10.3) | 81 (9.3) | −44.9 (−58.0 to −27.7) | |
| Colon and rectum | 184 (12.9) | 115 (13.3) | −37.5 (−50.5 to −21.1) | |
| Pancreas | 41 (2.9) | 37 (4.3) | −9.8 (−42.1 to +40.7) | |
| Lungd | 209 (14.6) | 164 (18.9) | −21.5 (−36.0 to −3.8) | |
| Skin-melanoma | 81 (5.7) | 56 (6.5) | −30.9 (−50.8 to −2.8) | |
| Breastd | 370 (25.9) | 227 (26.2) | −38.6 (−48.0 to −27.6) | |
| Cervix | 35 (2.4) | 9 (1.0) | −74.3 (−87.6 to −46.6) | |
| Prostate | 233 (16.3) | 66 (7.6) | −71.7 (−78.4 to −62.8) | |
| Non-Hodgkin lymphoma | 81 (5.7) | 75 (8.7) | −7.4 (−32.4 to +26.8) | |
| Leukemia | 22 (1.5) | 18 (2.1) | <0.001 | −18.2 (−56.1 to +52.5) |
| Stagee | ||||
| I | 455 (35.5) | 216 (30.9) | −52.5 (−59.6 to −44.2) | |
| II | 282 (22.0) | 151 (21.6) | −46.5 (−56.1 to −34.7) | |
| III | 246 (19.2) | 113 (16.2) | −54.1 (−63.2 to −42.6) | |
| IV | 297 (23.2) | 219 (31.3) | 0.001 | −26.3 (−38.4 to −12.2) |
| Missing | 47 | 74 | 57.4 (+9.2 to +126.9) | |
| Symptomatic | ||||
| No | 524 (36.6) | 224 (25.9) | −57.3 (−63.4 to −50.0) | |
| Yes | 799 (55.9) | 586 (67.7) | <0.001 | −26.7 (−34. to −18.4) |
| Unknown | 107 | 56 | −47.7 (−61.1 to −27.7) | |
| Referral pathway | ||||
| Doctor | 730 (51.0) | 488 (56.3) | −33.2 (−40.4 to −25.0) | |
| Another hospital | 494 (34.6) | 258 (29.8) | −47.8 (−55.1 to −39.3) | |
| Organized screening | 142 (9.9) | 38 (4.4) | −73.2 (−81.3 to −61.7) | |
| Opportunistic screening | 31 (2.2) | 16 (1.9) | −48.4 (−71.8 to −5.6) | |
| Appointment | 30 (2.1) | 54 (6.2) | <0.001 | 80.0 (+15.2 to +181.2) |
| Missing | 3 | 12 | 300.0 (+12.9 to +1317.4) | |
| First treatmentf | ||||
| Surgery | 510 (35.7) | 219 (25.3) | −57.1 (−63.3 to −49.7) | |
| Radiotherapy | 209 (14.6) | 50 (5.8) | −76.1 (−82.4 to −67.4) | |
| Brachytherapy | 28 (2.0) | 5 (0.6) | −82.1 (−93.1 to −53.7) | |
| Systemic treatment | ||||
| Chemotherapy | 280 (19.6) | 187 (21.6) | −33.2 (−44.5 to −19.6) | |
| Chemoradiotherapy | 26 (1.8) | 3 (0.3) | −88.5 (−96.5 to −61.9) | |
| Immunotherapy | 4 (0.3) | 6 (0.7) | 50.0 (−57.7 to +431.5) | |
| Targeted therapy | 12 (0.8) | 24 (2.8) | 100.0 (0.00 to +300.0) | |
| Hormone therapy | 78 (5.4) | 40 (4.6) | −48.7 (−65.0 to −24.9) | |
| Other | 1 (0.1) | 3 (0.3) | 200.0 (−68.8 to +2784.1) | |
| None (as of 1 July)g | 282 (19.3) | 329 (38.0) | <0.001 | 16.7 (−0.5, to +36.8) |
| Complications | ||||
| Anastomotic dehiscence (yes)h | 10 (2.0) | 2 (0.9) | 0.308 | −80.0 (−95.6 to −8.7) |
| Clavien–Dindo Classificationh (Clavien et al., 2009) | ||||
| None | 449 (88.0) | 200 (91.3) | −55.5 (−62.3 to −47.4) | |
| I–II | 37 (7.2) | 12 (5.5) | −67.6 (−83.1 to −37.8) | |
| III–V | 24 (4.7) | 7 (3.2) | 0.422 | −70.8 (−87.4 to −32.3) |
| Cancer-specific emergency visits (yes)i | 173 (12.3) | 131 (15.3) | 0.038 | −24.3 (−39.6 to −5.0) |
| Hospitalizations (yes)i | 341 (24.1) | 203 (23.7) | 0.875 | −40.2 (−50.0 to −29.2) |
| COVID-19 (yes)i,j | 1 (0.1) | 4 (0.5) | – | – |
CI, confidence interval; COVID-19, coronavirus disease 2019.
aCalculated using Poisson regression.
bPorto Metropolitan Area includes the following municipalities: Arouca, Espinho, Gondomar, Maia, Matosinhos, Oliveira de Azeméis, Paredes, Porto, Póvoa de Varzim, Santa Maria da Feira, Santo Tirso, São João da Madeira, Trofa, Vale de Cambra, Valongo, Vila Nova de Gaia, Vila do Conde.
cInternational Statistical Classification of Diseases and Related Health Problems 10th Revision (World Health Organization, 1992): esophagus – C15; stomach – C16; colon and rectum – C18–20; pancreas – C25; lung – C34; skin-melanoma – C43; breast – C50; cervix – C53; prostate – C61; non-Hodgkin lymphoma – C82–86, C96; leukemia – C91–95.
dLung: 95 left, 106 right, 8 unknowns/missing and 72 left, 88 right, 4 unknowns/missing; breast: 182 left, 182 right, 6 unknowns/missing and 117 left, 106 right, 4 unknowns/missing in 2 March 2019 to 1 July 2019 and 2 March 2020 to 1 July 2020, respectively.
eSolid tumors only (P values for comparisons do not include unknowns). Esophagus: 0 I, 2 II, 7 III, 14 IV, 4 unknowns and 0 I, 1 II, 4 III, 9 IV, 4 unknowns (P value = 0.974); stomach: 42 I, 13 II, 24 III, 56 IV, 12 unknowns and 11 I, 3 II, 6 III, 37 IV, 24 unknowns (P value = 0.032); colon and rectum: 28 I, 47 II, 63 III, 37 IV, 9 unknowns and 14 I, 23 II, 39 III, 25 IV, 14 unknowns (P value = 0.776); pancreas: 4 I, 5 II, 6 III, 23 IV, 3 unknowns and 4 I, 3 II, 7 III, 19 IV, 4 unknowns (P value = 0.894); lung: 42 I, 14 II, 33 III, 115 IV, 5 unknowns and 27 I, 14 II, 18 III, 99 IV, 6 unknowns (P value = 0.380); skin-melanoma: 37 I, 18 II, 20 III, 6 IV and 28 I, 13 II, 3 III, 3 IV, 9 unknowns (P value = 0.069); breast: 263 I, 65 II, 20 III, 13 IV, 9 unknowns and 120 I, 61 II, 23 III, 14 IV, 9 unknowns (P value < 0.001); cervix: 7 I, 21 II, 4 III, 3 IV and 2 I, 6 II, 1 III, 0 IV (P value = 0.840); prostate: 32 I, 97 II, 69 III, 30 IV, 5 unknowns and 10 I, 27 II, 12 III, 13 IV, 4 unknowns (P value = 0.237) in 2019 and 2020, respectively.
fFirst treatment received until 1 July of the respective year of diagnosis. 54 and 30 cases (2019 and 2020, respectively) received chemotherapy and targeted therapy on the same day, chemotherapy was considered as first; 1 case (2020) received hormone therapy and targeted therapy on the same day, hormone therapy was considered as first; 2 cases (2019) received chemotherapy and hormone therapy on the same day, chemotherapy was considered as first; 209 and 50 cases (2019 and 2020, respectively) received hormone therapy and radiotherapy on the same day, hormone therapy was considered as first.
gReasons for no treatment: 168 and 259 cases awaiting treatment to begin; 22 and 19 cases with cancer too advanced for treatment; 24 and 24 cases cannot undergo treatment due to current physical condition; 36 and 8 cases currently under surveillance; 32 and 19 cases died before any treatment in 2019 and 2020, respectively.
hFollow-up until 1 July of the respective year of diagnosis. Among those who underwent surgery as first treatment (n = 510 and n = 219 in 2019 and 2020, respectively).
iFollow-up until 1 July of the respective year of diagnosis. Among 1412 patients with cancer (18 patients had two primary cancers) and 855 patients with cancer (11 patients had two primary cancers) in 2019 and 2020, respectively.
jCOVID-19 diagnosis between 2 March and 1 July 2020.