Abstract
BackgroundPatients with hepatocellular carcinoma (HCC) represent a vulnerable population potentially negatively affected by COVID-19-associated reallocation of healthcare resources. Here, we report the impact of COVID-19 on the management of HCC patients in a large tertiary care hospital.MethodsWe retrospectively analyzed clinical data of HCC patients who presented at the Vienna General Hospital, between 01/DEC/2019 and 30/JUN/2020. We compared patient care before (period 1) and after (period 2) implementation of COVID-19-associated healthcare restrictions on 16/MAR/2020.ResultsOf 126 patients, majority was male (n = 104, 83%) with a mean age of 66±11 years. Half of patients (n = 57, 45%) had impaired liver function (Child-Pugh stage B/C) and 91 (72%) had intermediate-advanced stage HCC (BCLC B-D). New treatment, was initiated in 68 (54%) patients. Number of new HCC diagnoses did not differ between the two periods (n = 14 vs. 14). While personal visits were reduced, an increase in teleconsultation was observed (period 2). Number of patients with visit delays (n = 31 (30%) vs. n = 10 (10%); p = 0.001) and imaging delays (n = 25 (25%) vs. n = 7 (7%); p = 0.001) was higher in period 2. Accordingly, a reduced number of patients was discussed in interdisciplinary tumor boards (lowest number in April (n = 24), compared to a median number of 57 patients during period 1). Median number of elective/non-elective admissions was not different between the periods. One patient contracted COVID-19 with lethal outcome.ConclusionsChanges in patient care included reduced personal contacts but increased telephone visits, and delays in diagnostic procedures. The effects on long-term outcome need to be determined.
Highlights
Since December 2019, when the first cases of coronavirus disease 19 (COVID-19) were identified in Wuhan, China, severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), a novel enveloped RNA betacoronavirus, rapidly spread across the globe, imposing numerous challenges on countries’ health systems and economies [1, 2]
Number of new hepatocellular carcinoma (HCC) diagnoses did not differ between the two periods (n = 14 vs. 14)
A reduced number of patients was discussed in interdisciplinary tumor boards (lowest number in April (n = 24), compared to a median number of 57 patients during period 1)
Summary
Since December 2019, when the first cases of coronavirus disease 19 (COVID-19) were identified in Wuhan, China, severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), a novel enveloped RNA betacoronavirus, rapidly spread across the globe, imposing numerous challenges on countries’ health systems and economies [1, 2]. COVID-19-associated healthcare restrictions challenged the treatment of patients with chronic diseases and malignancies, including patients with HCC. Patients with cancer are a high-risk group in the COVID-19 pandemic. They are more susceptible to any kind of infection due to an immunodeficient state caused by the underlying malignancy and anti-cancer treatments, such as systemic therapies and radiotherapy. As they require close follow-up, they are recalled to the hospitals more often, which further increases their risk of contracting SARS-CoV-2 infection [9]. Patients with hepatocellular carcinoma (HCC) represent a vulnerable population potentially negatively affected by COVID-19-associated reallocation of healthcare resources. We report the impact of COVID-19 on the management of HCC patients in a large tertiary care hospital
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