The impact of the COVID-19 pandemic on the diagnosis, treatment and survival of patients with cancer.

Summary:

Coronavirus disease 2019 (COVID-19) has caused over 113 million confirmed cases and 2.52 million deaths worldwide. In 3/2020, Portugal had a rapid response to the pandemic imposing a full national lockdown. The country had a surge in new cases, in the fall, and then, in 1/2021, Portugal registered the highest case and death rate.

Health systems introduced significant adjustments to services to ensure essential care while reducing the risk of COVID-19 in patients and healthcare professionals, and ensuring sufficient resources for in-patient care of serious COVID-19 cases. In particular, oncology centers had to consider how to balance the delay in diagnosis or treatment against the risk of COVID-19. Cancer patients may suffer a double burden due to the pandemic. First, there was a decrease in the number of cancer cases due to fewer routine visits with healthcare professionals and many cancer screening programs were suspended. Second, those with active cancer may have a higher risk of infection and be more vulnerable to complications.

Therefore, this project aims to study the impact of the COVID-19 pandemic on the diagnosis, care and survival of cancer patients from the Portuguese Oncology Institute in Porto (IPOP) throughout the pandemic, by comparing 3 periods, covering the 3 waves after the outbreak began in Portugal, with the same 3 periods from before. The specific research objectives are:

• To describe and compare the median times from symptoms onset, 1^st medical exam and 1^st appointment to diagnosis, and from diagnosis to 1^st appointment, multidisciplinary tumor board meeting and 1^st treatment among patients diagnosed with cancer before and after COVID-19 with follow-up to 2/9/2020 and 2021, respectively;
• To quantify the impact of the outbreak on the survival of patients diagnosed with cancer before and after COVID-19 with vital status follow-up to 31/3/2022 and 2023, respectively.

An additional objective is to compare the sociodemographic characteristics, clinical presentation and outcomes between patients diagnosed with cancer at IPOP and with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and those without infection.

Cancer cases of the esophagus, stomach, colon and rectum, pancreas, lung, skin-melanoma, breast, cervix, prostate, non-Hodgkin lymphoma, and leukemia, diagnosed in 2/3/2019–1/3/2020 (before), and 2/3/2020–1/3/2021 (after) at IPOP will be identified. Information on sociodemographic, clinical and treatment characteristics will be collected with follow-up to 2/9/2020 or 2021. Vital status and date of death will be assessed up to 31/3/2022 and 2023, and cause of death will be obtained, if available. Information regarding COVID-19 diagnosis in 2/3/2020–2/9/2021 will be obtained. Patients with COVID-19 will be matched (1:1; by cancer site and year of diagnosis) to patients without COVID-19.

We expect the results of this study to elucidate how the initial decrease in cancer cases, responses by government, healthcare services and patients, and the surge in COVID-19 cases overtime will impact the diagnosis, care and survival of cancer patients in Northern Portugal over a period of 1 year with a minimum vital status follow-up of 2 years.