Short-Term Outcomes of COVID-19 Pandemic on Non-Small Cell Lung Cancer Screening and Management

Our plain-English summary of Short-Term Outcomes of COVID-19 Pandemic on Non-Small Cell Lung Cancer Screening and Management, by F. Orelaru, M. Edwards, R. Raleigh, et al (The Surgery Journal, 2023).

The study

• Authors: F. Orelaru, M. Edwards, R. Raleigh, A. Abunayla, R. Bush, S. Porter, K. Schumaker, J. Albright, K.N. Adams
• Journal: The Surgery Journal
• Published: 2023;9(4):e156-e161
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background To assess the impact of coronavirus disease 2019 (COVID-19) pandemic on non-small cell lung cancer (NSCLC) screening, staging, and management in a single health care system. Materials and Methods From November 2015 to December 2020, a total of 1,547 NSCLC cases was reported at our institution including 1,329 cases pre-COVID-19 and 218 cases during COVID-19. Pre-COVID-19 was defined as November 2015 to February 2020, while during COVID-19 was March 2020 to December 2020. Data were collected from tumor registry and medical record review. Patients with mesothelioma, lymphoma, small cell, or mixed small cell cancer were excluded from the study. Results Both pre-COVID-19 and during COVID-19 cohorts had similar comorbidities including age (70 vs. 71 years), current smokers (35 vs. 32%), and chronic obstructive lung disease (32 vs. 28%). The number of low-dose computed tomography lung cancer screening scans decreased by 25% during COVID-19 compared with pre-COVID-19 era. There were more cases of stage 1A NSCLC pre-COVID-19 (31 vs. 25%) and more stage 4 cancer during COVID-19 (42 vs. 33%); p = 0.01. The proportion of patients treated with radiotherapy was similar between pre-COVID-19 and during COVID-19 (49 vs. 50%), but fewer patients underwent surgery during COVID-19 (17 vs. 27%; p = 0.004). The median time to radiotherapy (67 days) and surgery (29 days) was similar between the groups. The unadjusted overall 6-month mortality after lung cancer diagnoses was higher during COVID-19 compared with pre-COVID-19 (28 vs. 22%; p = 0.04). Conclusion The COVID-19 pandemic resulted in delayed lung cancer screening scans, and more patients had diagnosis of advanced NSCLC; however, short-term mortality was unchanged.

The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. ( https://creativecommons.org/licenses/by/4.0/ ).

In plain English

This study is about lung cancer care during the COVID-19 pandemic. It did not study asbestos, and patients with mesothelioma were excluded. The authors looked back at records of 1,547 cases of non-small cell lung cancer reported at Trinity Health Ann Arbor, Chelsea, and Livingston hospitals in Michigan. They compared 1,329 cases from November 2015 to February 2020 with 218 cases from March to December 2020. Routine low-dose CT screening scans fell by 25% during the pandemic. Stage 4 cancer made up 42% of cases during the pandemic versus 33% before. Fewer patients had surgery during the pandemic (17% versus 27%), while radiotherapy use and time from diagnosis to treatment were similar. Before adjustment, death within 6 months of diagnosis was higher during the pandemic (28% versus 22%). After adjusting for demographics and comorbidities, that difference was not statistically significant. Deaths at 30 days and 1 year did not differ significantly. The authors noted that results from one health system may not apply elsewhere.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective analysis of tumor registry and medical record data from a single health care system, comparing a pre-COVID-19 period with a during-COVID-19 period
• Who was studied: 1,547 non-small cell lung cancer cases (1,329 pre-COVID-19, 218 during COVID-19) reported at Trinity Health Ann Arbor, Chelsea, and Livingston hospitals in Michigan, November 23, 2015 to December 28, 2020; patients 18 or older; patients with mesothelioma, lymphoma, small cell or mixed small cell cancer were excluded
• Exposure: The comparison was by time period of diagnosis: during the COVID-19 pandemic (March 2020 to December 2020) versus before it (November 2015 to February 2020). Asbestos exposure and asbestos fibers were not studied.
• Main results:
  • The yearly number of routine low-dose CT lung cancer screening scans had risen by 20 to 30% per year before COVID-19 and decreased by 25% during COVID-19
  • Stage 4 non-small cell lung cancer was more common during COVID-19 than before (42% vs. 33%, p equal to 0.01)
  • The median clinical stage was 3A in the pre-COVID-19 period and 3B in the COVID-19 period
  • Fewer patients had surgical resection during COVID-19 (17% vs. 27%, p equal to 0.004; Table 2: 38 of 218, 17.43%, vs. 359 of 1,329, 27.01%)
  • The proportion treated with radiotherapy (SABR) was similar: 49.54% during COVID-19 vs. 49.01% pre-COVID-19 (p equal to 0.944, Table 2)
  • Median time from diagnosis to radiotherapy (67 vs. 67 days, p equal to 0.82) and to surgery (Table 2: 29.5 vs. 29 days, p equal to 0.641) was similar between periods
  • Unadjusted 6-month (180-day) mortality after diagnosis was higher during COVID-19 than before (28% vs. 22%, p equal to 0.04)
  • After adjusting for demographics and comorbidities, the 6-month mortality difference was not statistically significant (p equal to 0.63)
  • Unadjusted and adjusted 30-day and 1-year mortality did not differ significantly between periods
  • Among patients treated with radiotherapy, 1-year mortality was 17% pre-COVID-19 vs. 12% during COVID-19, not a significant difference (p equal to 0.1). Among patients who had surgery, it was 2.03% vs. 0.46% (p equal to 0.17).
• The authors' conclusion: The authors concluded that the COVID-19 pandemic affected the use of routine low-dose CT lung cancer screening and that more patients had metastatic non-small cell lung cancer at diagnosis during the pandemic. They concluded that unadjusted short-term mortality was higher during the pandemic but similar to the pre-COVID-19 era after adjusting for comorbidities.
• Limitations the authors state:
  • The study covered a single health care system and may not be generalizable to other US hospitals
  • The drop in screening CT scans may not be due solely to the COVID-19 pandemic
  • The higher share of stage 4 cancer during COVID-19 may reflect more advanced patients coming to hospital with worse respiratory symptoms

Topics

Medical terms in this study, explained in our Lexicon: Non-Small Cell Lung Cancer, Staging, Cancer Registry, Mesothelioma, Obstructive Lung Disease, Low-Dose CT Screening, Lung Cancer.

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