Impact of COVID-19 pandemic on lung cancer diagnosis in a community hospital.

Abstract

e18634 Background: Coronavirus disease 2019 (COVID 19) pandemic saw its first case in the United States in 2020. Although lung imaging for COVID-19 patients theoretically increased chances of detecting cancerous lung nodules, strict quarantine measures disrupting routine cancer screening was a concern. Real-world data on lung cancer diagnosis during the pandemic at community level is less known. Methods: We conducted a retrospective chart review on patients newly diagnosed of lung cancer from 2018- 2022 in our community hospital. Demographic details, year of diagnosis, type and stage of cancer, inpatient or outpatient diagnosis and mode of diagnosis (surveillance, incidental or symptomatic) was noted. Descriptive analysis of the above parameters was conducted across three eras- 2018 and 2019 as pre-COVID era (PreCo), 2020 and 2021 as COVID era (Cov) and 2022 as post-COVID era (PosCo) irrespective of COVID-19 diagnosis. Results: Out of 287 patients included, 40% (116) were diagnosed during PreCo, 27.5% (79) during Cov and 32% (92) during PosCo. In the PreCo, 16% (19) were incidentally detected, 21% (24) were ISym, 48% (56) on surveillance, and 15% (17) were OSym. In Cov, 13.9% (11) were incidentally detected, 53.3% (42) were ISym 13.9% (11) on surveillance, and 18.9% (15) were OSym. In PosCo, 11.3% (11) were incidentally detected, 19% (18) were ISym, 44% (41) on surveillance, and 24% (22) were OSym. Stage IV cancers among new lung cancer diagnoses were noted to be highest in PosCo (43.4%) followed by PreCo (31.9%) and Cov (26.6%). Conclusions: Cov saw a decrease in the annual rate of new lung cancer diagnosis compared to PreCo likely secondary to reduced routine screening. A staggering increase in new and stage IV cancers were noted in PosCo which could stem from missed screening as well as rapid progression of undiagnosed cancers during the pandemic. In Cov, there was a dramatic increase in symptomatic inpatient lung cancer cases (53.3%) as symptoms of COVID-19 and lung cancer overlap. Comparable rates of cancer diagnosis via surveillance in PosCo (44%) and PreCo (48%) hints at possible restoration of access to outpatient cancer care. [Table: see text]