Effect of lockdown on digestive system cancer care amongst older patients during the first wave of COVID-19: The CADIGCOVAGE multicentre cohort study

Thomas Aparicio,Richard Layese,François Hemery,Christophe Tournigand,Elena Paillaud,Nicola De Angelis,Laurent Quero,Nathalie Ganne,Fredéric Prat,Atanas Pachev,Gilles Galula,Marc-Antoine Benderra,Florence Canouï-Poitrine

doi:10.1016/j.dld.2021.09.017

Abstract

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has had a dramatic impact on cancer diagnosis and treatment. Most patients newly diagnosed with digestive system cancer are aged 65 and over. MethodsWe performed a retrospective, observational, multicentre cohort study based on prospectively collected electronic health records. All adults aged 65 or over and having been newly treated for a digestive system cancer between January 2018 until August 2020 were enroled. ResultsData on 7882 patients were analysed. The first COVID-19 lockdown period led to a 42.4% decrease in newly treated digestive system cancers, and the post-lockdown period was associated with a 17% decrease. The decrease in newly treated digestive system cancer did not differ as a function of age, sex, comorbidities, primary tumour site, and disease stage. The proportion of patients admitted to an emergency department increased during the lockdown period. We do not observe a higher 3-month mortality rate in 2020, relative to the corresponding calendar periods in 2018 and 2019. ConclusionTo avoid a decrease in newly treated cancers during future lockdown periods, access to healthcare will have to be modified. Although 3-month mortality did not increase in any of the patient subgroups, the 2020 cohort must be followed up for long-term mortality.

Highlights

The first COVID-19 lockdown period led to a 42.4% decrease in newly treated digestive system cancers, and the post-lockdown period was associated with a 17% decrease
The patients treated during the lockdown period did not differ from those treated during reference periods, except that the proportion of patients admitted with a digestive system cancer in an emergency department was higher during the lockdown period
The relative reductions in the number of newly treated cancer patients during the lockdown period were greatest in the 80–84 age group (Fig. 2A), for oesophagus and gastric cancer (Fig. 2C), for patients with metastasis (Fig. 2D), and for patients not treated in an emergency department (Fig. 2F)

Summary

Introduction

Most patients newly diagnosed with digestive system cancer are aged 65 and over. All adults aged 65 or over and having been newly treated for a digestive system cancer between January 2018 until August 2020 were enroled. The first COVID-19 lockdown period led to a 42.4% decrease in newly treated digestive system cancers, and the post-lockdown period was associated with a 17% decrease. The decrease in newly treated digestive system cancer did not differ as a function of age, sex, comorbidities, primary tumour site, and disease stage. The proportion of patients admitted to an emergency department increased during the lockdown period. Conclusion: To avoid a decrease in newly treated cancers during future lockdown periods, access to healthcare will have to be modified. 3-month mortality did not increase in any of the patient subgroups, the 2020 cohort must be followed up for long-term mortality

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