Malignant mesothelioma diagnosis and survival in the time of COVID-19 in Northeastern Italy

Abstract

Early data suggest a decrease in the diagnosis of new cancers and, consequently, an increase in avoidable deaths during the COVID-19 pandemic. To assess the impact of the pandemic on new diagnoses of malignant mesothelioma and survival in a population-based setting, we analysed 109 patients records from the Friuli Venezia Giulia Register during the period 2019-2020. Clinical data and information on COVID-19 diagnosis were retrieved and the number of mesothelioma diagnoses recorded in 2020 was compared to those recorded in 2019. A 2019-2020 comparison was also performed for survival time. Compared to 2019, in 2020 the total number of mesothelioma diagnoses and pleural cases increased by 9.2% and 16.7%, respectively, whereas peritoneal cases decreased by 45.2%. Mesothelioma distribution by period of diagnosis in 2020 showed no significant changes during the lockdown period, compared to the same period of the previous year, with an increase (+36.36%) in June-September and a decrease (-60%) in the second wave of the pandemic. Only six patients developed COVID-19. For the period 2019-2020, median survival was 11.5 and 7 months for pleural and peritoneal mesothelioma, respectively. Younger age (p<0.01) and epithelioid histology improved survival. Compared to 2019, in 2020 median survival was worse for peritoneal mesotheliomas (6 versus 12.5 months) and females (6 versus 9 months). Overall, the pandemic did not affect mesothelioma diagnosis, but survival is still poor. Our data evidence the indirect impact of the pandemic control measures on delays in cancer diagnosis and treatment, which in turn may have had a major effect on survival time. This means that early diagnosis is essential to ensure the clinical management of mesothelioma patients and provide adequate support and compensation.