716P Impact of COVID-19 pandemic on clinical outcomes in hepatocellular carcinoma: A multicentre cohort study

Abstract

Hepatocellular carcinoma (HCC) accounts for 90% of all liver cancer cases and is the fifth most common form of cancer. HCC remains the second most common cause of cancer-related death. Patients with early-stage disease may be treated surgically with resection, liver transplantation, or percutaneous ablation with curative intent. COVID-19 pandemic has caused severe disruption of healthcare services worldwide and has interrupted patients’ access to essential services. During the first wave, many healthcare services were shut to all but emergencies. However, the immediate and long-term impact of COVID-19 on clinical outcomes in HCC are unknown. In this study, we aimed to determine the indirect impact of COVID-19 health service utilisation on HCC outcomes. A prospective cohort study was conducted from March 15 until June 30 2020. Patients were enrolled from 8 tertiary hospitals in the UK and Germany with dedicated HCC management services. All patients with current or past HCC who were discussed at a multidisciplinary meeting (MDT) were identified. Hospital medical records, HCC MDT notes and hospital HCC databases were used to gather patient demographic and HCC related clinical data. Presence of the COVID-19 pandemic was operationalised as the time period during which the first wave of COVID-19 pandemic was present in the UK. Any delay to treatment (DTT) and the effect on survival at 1 year were reported. Any delay to treatment (DTT) and the effect on survival at 1 year were reported. The median time from MDM discussion to commencement of treatment was 49 days (IQR 26-83), with 70.1% of patients commencing treatment after 31 days of MDM discussion (n=171). Patients with BCLC stages-A/B disease were more likely to experience DTT. Significant delays across all treatments for HCC were observed but delay was most marked for those undergoing curative therapies. Even though severe delays were observed in curative HCC treatments, this did not translate in reduced survival in patients. Interruption of routine healthcare services because of the COVID-19 pandemic caused severe delays in HCC treatment. However, DTT did not translate to reduced survival. Longer follow is important given the delay to therapy in those receiving curative therapy.