Impact of the COVID-19 pandemic in cancer diagnosis in the first and second waves in one of the most affected cancer areas in the city of Madrid (Spain).

Abstract

Since January 2020, we have been immersed in an almost unprecedented health crisis caused by the COVID-19 pandemic.1 More than 330 000 cases have been reported only in the Madrid region (Spain), causing more than 10 000 deaths until November.2 In fact, Madrid has been one of the most affected regions by the COVID-19 pandemic in both the first and second epidemic waves. In the current second wave, our center, located in one of the most affected areas within the city of Madrid, reached the peak of admissions during the last week of September and the first days of October. During the first wave, our center, as well as others in the city of Madrid, exceeds its capacity because of COVID-19 admissions, reaching an occupancy rate of over 200% of its usual capacity (meaning an approximate number of 750 beds occupied by COVID-19 patients). For this reason, hospital activity was restricted almost exclusively in hospitalized COVID-19 patients. However, cancer patients, along with other patients with chronic diseases, needed to continue their hospital attention. This is a crucial issue as, on the one hand, cancer patients are highly vulnerable to SARS-CoV-2 infection, as it is reported in our series3, 4 as well as in other international series,5, 6 with high mortality rates. On the other hand, we also know that the delay in the diagnosis and treatment of cancer patients can sometimes be fatal.7, 8 Thus, an adequate risk/benefit balance is needed when deciding which hospital activities should be maintained when occupancy rates by COVID-19 are high. As a matter of fact, we can observe a double burden of COVID-19 in cancer patients: the effects of the SARS-CoV-2 infection, with high fatality rates,3-6 and the effects of a decrease in the new diagnosis.8 This decrease in new diagnosis is probably caused by fear to visit hospitals where the virus is present, as well as the restrictions in the usual hospital activity for extended periods of time. Given this, in this letter, we show how the peak of COVID-19 first wave in the city of Madrid, and therefore, the peak of hospital admissions of COVID-19, has been associated with a dramatic decrease in the new referrals of cancer patients in our center in the following months after the peak of COVID-19. During the first wave, a decrease of 31.11% of new oncology referrals was observed, meaning that almost 1 in 3 patients was diagnosed later than usual, with the consequences that this may have for the prognosis of our patients. On the other hand, oncological treatments were maintained in usual numbers (Table 1), despite the fact that, in most cases, doses were spaced according to SEOM (Spanish Society of Medical Oncology, in its acronym in Spanish) and ESMO (European Society of Medical Oncology) recommendations.9, 10 Regarding successive visits after referral, there was also a decrease of 28.17%, probably because a large part of them were remote visits. At present, once we know that COVID-19 pandemic will not be over in the following months, there is a need for a proper balance between medical attention to the SARS-CoV-2 patients and regular attention to other patients. We have tried to find this balance in our center during the second wave, where the decrease in new oncology referrals is not as dramatically lower as during the first wave. In the second wave, we have only seen the decrease in new referrals reduced by 17.39%, keeping both cancer treatments and successive visits at the same levels. Besides, telematic visits have increased up to 137%, which represents a 11% of the total successive visits. This increase is a reflection of the adaptations that have been made to the medical attention of our center during the second wave of the COVID-19 (Supplementary Table 1). In summary, the COVID-19 pandemic has affected hospital care in all areas, especially in the first wave. Cancer patients are among the most affected, either because of the high rate of complications that infected cancer patients present or by the decrease and probable delay of new diagnoses. For this reason, it is important to develop safety protocols and preventive measures, as has been done in our center. These measures were aimed to prevent the restriction of regular activity (as it happened in the first wave) and to succeed that cancer patients are diagnosed and start treatments at the right time to prevent future complications. The authors declare no conflict of interest. Supplementary Table 1. Number and kind of successive visits in our center during the two first waves of COVID-19. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.