FP06.02 The Impact of The COVID-19 Pandemic on New Diagnoses of Lung Cancer: A 3-Year Review of an Irish Cancer Centre

Abstract

The onset of the COVID-19 pandemic in March 2020 led to a disruption in cancer services worldwide. In Ireland, lung cancer is the fourth most common malignancy and the leading cause of cancer deaths. Disease stage at diagnosis and performance status are powerful prognostic factors for survival in both non-small cell (NSCLC) and small cell lung cancer (SCLC) subtypes. We review cases of lung cancer diagnosed over a consecutive three-year period to better understand the impact of the COVID-19 pandemic on this cohort of patients. We conducted a retrospective analysis of new cases of primary lung cancer referred to the lung cancer multidisciplinary meeting (MDM) at a tertiary referral cancer centre in Dublin, Ireland, between December 2017 and November 2020. Histological subtypes included for analysis: NSCLC (adenocarcinoma, squamous cell carcinoma, and carcinoma not otherwise specified) and SCLC. Exclusion criteria: patients without a histologically confirmed diagnosis of primary lung cancer, other histological subtypes, and patients referred for systemic anti-cancer treatment and follow-up at an external institution. We reviewed case numbers, patient demographics, disease stage at presentation, performance status at the time of diagnosis, and survival. A total of 491 cases of lung cancer diagnosed between December (‘Dec’) 2017 and November (‘Nov’) 2020 were included for analysis. 162 cases were diagnosed between Dec 2017 and Nov 2018, 181 cases between Dec 2018 and Nov 2019, and 148 cases between Dec 2019 and Nov 2020. We compared patients diagnosed between Dec 2017 and Nov 2019 to those diagnosed between Dec 2019 and Nov 2020 to assess the impact of the pandemic: Gender: 61% vs 45% male (p=0.0013). Median age: 69 vs 67 years (p=0.26). NSCLC stage I disease 31.6% vs 22.3% (p=0.03); stage IV disease 34.4% vs 46.3% (p=0.01). SCLC extensive stage 67.3% vs 74.1% (p=0.55). Metastatic disease: 39.1% vs 51.4% (p=0.03). Performance status ≥ 2: 27.2% vs 24.4% (p=0.52). Median overall survival (mOS): 14 months vs not reached. Between December 2019 and November 2020, fewer primary lung cancer cases were diagnosed at our centre compared to the preceding two years. Of these patients, a higher number presented with metastatic disease. There was no statistically significant difference in the performance status of patients at presentation. We hypothesize that the increase in advanced stage presentations seen during the pandemic may be accounted for by the disruption to cancer services, delayed presentations due to patients following public health advice and self-isolating in response to new respiratory symptoms, and fewer patients presenting to healthcare providers due to the fear of contracting COVID-19.