OGC P06 Has the affluent oesophageal cancer population in Scotland fared worseduring the Covid-19 pandemic?

Abstract

Abstract Background COVID-19 has significantly disrupted cancer care. This has impacted on staging, management and survival of oesophageal cancer as health services worldwide had to adapt. Responding to the pandemic, the UK government declared a national lockdown on 23rd March 2020. Our aim was to determine the impact of COVID-19 and socio-economic deprivation on patients with oesophageal cancers. Methods This was a retrospective cohort study. Consecutive new patients presenting in NHS Scotland to five regional OG cancer MDTs covering 93.2% of the Scottish population between October 2019 and September 2020 were identified. Electronic health records were reviewed. Patient's residential address was used to calculate Scottish Index of Multiple Deprivation (SIMD). Patients were divided into two groups: most deprived (SIMD 1–5) and least deprived (SIMD 6–10) and results compared. The study period was divided into pre- and post-lockdown, based on the first UK national lockdown on 23rd March 2020. Results 728 patients with were identified, 5 were excluded due to unrecognised postcode. 365 (50.5%) were in the more deprived and 358 (49.5%) were in least deprived group. 488 (67.0%) were male and the median age was 71 years (range 25-95). Deprivation and lockdown: Age, sex, WHO performance status and route of referral was not significantly different. No clinically meaningful difference in median time to gastroscopy was observed. Palliative intent treatment increased in the most deprived from 67.0% to 71.4% and in least deprived from 54.0% to 74.0% (p=0.002). The overall survival for the whole cohort decreased post-lockdown (11.3 vs 7.8 months, p=0.001). Pre-lockdown the median survival for most deprived group was 8.9 vs 15 months for the least deprived group (p=0.001). Post-lockdown the median survival was similar irrespective of socioeconomic status (7.8 vs 6.9 months, p=0.99). The medial survival did not changed post-lockdown for the most deprived group (8.9 vs 7.8 months, p=0.480). However, the median survival for the least deprived group significantly decreased post lockdown (15 vs 6.9 months, p<0.001). A test of heterogeneity between lockdown period and SIMD group supported the suggestion that least deprived group did worse post-lockdown (HR 1.45, p=0.035). Conclusions This national study highlights that the least deprived patients had survival advantage pre-lockdown, which has been completely lost due to the lockdown. This disproportionate impact on the least deprived patients could be because early cancers were not diagnosed in the least deprived population.