OGC P49 The legacy of the COVID-19 pandemic on patients with oesophago-gastric cancer

Abstract

Abstract Background The COVID-19 pandemic significantly impacted on healthcare systems worldwide, and likely affected every aspect of the patient pathway from diagnosis and treatment to long-term outcomes. Whilst much has been inferred about the impact on patients with oesophago-gastric (OG) cancer, very little granular data or understanding currently exists about how and why outcomes may have differed to pre-COVID times. This study aimed to investigate the effect of the pandemic on key aspects of the patient pathway, including decision-making in MDTs and long-term survival on patients newly diagnosed with OG cancer. Methods This retrospective study compared patients from 2 distinct periods during the pandemic (March to August 2020 and March to August 2021) against a corresponding pre-pandemic period (March to August 2019). The setting was a regional OG tertiary cancer centre serving a population of 3.5 million people in the North West of England. The primary outcome was the rate of palliative intent pathways. Secondary outcomes included the rate of deviation from the standard of care (SoC) in MDT decision-making and changes in overall survival. MDT minutes were analysed for disease stage, management intent, treatment justification, and data on first treatment modality. Results 402 new patients were diagnosed between March-August 2019; 158 (39.3%) and 244 (60.7%) were initially allocated to curative and palliative pathways respectively. This dropped to 261 new cases (32% curative and 68% palliative) during March-August 2020 rose back up to 386 new cases (37% curative vs 63% palliative) during March-August 2021. The change in cases allocated to palliative pathways was significant (p=0.014). One-year overall survival for was 50.5%, 56.3%, and 51.6% for new diagnoses during 2019, 2020 and 2021 (p=0.316). There was no difference of rates of pathway deviations from standard of care comparing MDT decisions made during each time-period. Conclusions Fewer new patients were discussed, and a greater proportion of patients were allocated to palliative pathways during the first 6 months of the COVID-19 pandemic. This was not due to deviations from standard of care - which were widely reported during this period. Caseload and pathway allocation recovered by 2021 and 1-year overall survival did not change throughout, suggesting that despite other restrictions in place, treatment delivery remained effective throughout the pandemic. Further survival analyses over the coming years are required in order to explore the longer-term impacts of the pandemic on OG cancer patients.