Data from a single-center study in Scotland suggested that there were more patients with lung cancer admitted acutely with cancer, non-COVID-19-related illness during the COVID-19 pandemic.
“Early and late lockdown were characterized by a reduction in self-presentation and longer resulting admission suggesting that patients were admitted with more complex pathology and consequently had longer admission,” said Felix Torrance, MBBS, of Edinburgh Cancer Centre, Western General Hospital, NHS Lothian, United Kingdom, who presented the study (Abstract 3554) at IASLC 2020 World Conference on Lung Cancer.
Lung cancer patients experience many barriers to accessing healthcare, such as low socioeconomic status and guilt around their diagnosis, Dr. Torrance said. However, these patients often have comorbidities and need to access healthcare during their treatment.
“Anecdotally, we observed patients admitted during the pandemic were more unwell and required more intervention than normal,” he said.
In the study, Dr. Torrance and colleagues identified patients with suspected or previously diagnosed lung cancer who were admitted to Edinburgh Cancer Centre between March 29 and June 29, 2020. The study looked at early lockdown (March 29-April), late lockdown (May), and recovery (June). Admissions were compared with a similar audit group from April 2019. Patient demographics were gather from electronic health records.
During the three-month period, 77 patients were admitted (46 male). The mean age of patients was 65.8. In early lockdown, 29 patients were admitted; in late lockdown, 21; and in recovery, 27. In April 2019, 10 patients were admitted.
Patients were admitted for a longer period of time in early lockdown and late lockdown compared with recovery (7.4 vs. 7.0 vs. 2.7 days). Three inpatient deaths occurred in early lockdown, two in late lockdown, and none during the recovery period. This suggests that patients may have been presenting with more advanced cute illness during lockdown, Dr. Torrance said. In the control period in April 2019 the median admission length was 2 days with zero in-patient deaths occurring.
“We also found that the admission route shifted during the study period from being prompted by routine consultation to patient-driven self-presentation as the pandemic progressed,” Dr. Torrance said.
During early and late lockdown around half of patients were admitted after scheduled routine consultation (48% for early lockdown and 57% for late lockdown). In contrast, only 19% of patients were admitted via this route during the recovery period, with 41% admitted via self-presentation to the patient helpline and 37% self-presenting to their general practitioners or accident and emergency. By comparison to April 2019, 30% were via schedule consultation and 70% self-presenting.
“Overall our data highlights the need to make acute cancer services more accessible during the COVID-19 pandemic,” Dr. Torrance said. “Patients with lung cancer are a particularly vulnerable group.”
Finally, Dr. Torrance noted that the numbers from this study are small and only from one cancer center. It could be useful to look at overall early mortality throughout the United Kingdom to see if morbidity from cancer and the treatment was an overall issue during the CCOVID-19 pandemic.