Figure 4
Lockdown and delay to surgery (A) Delay from diagnosis to surgery during lockdowns (according to COVID-19 stringency index group) by neoadjuvant therapy group. Percentages represent proportion of operated patients who were in each interval from diagnosis to operation group. (B) Weeks in full lockdown and interval from cancer diagnosis to operation. Plot displays patients who went straight to surgery (no neoadjuvant therapy only). Full lockdown defined as a COVID-19 stringency index score of more than 60. Plotted line represents a smoothed conditional mean from a fitted generalised additive model. The shaded area denotes bounds of the 95% CI.
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Background: Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods: This internati...
Context in source publication
Context 1
... are therefore expressed as a percentage of 2001 non-operated patients and with data available. figure 4). Increasing SARS-CoV-2 case notifi cation rates were also associated with increased delays beyond 12 weeks across income groups, with the longest delays observed in UMICs and LMICs during periods with high SARS-CoV-2 rates (appendix p 23). ...
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Background: Breast cancer is a common malignancy, and early detection coupled with standardized treatment is crucial for patient survival and recovery. This study aims to scrutinize the current state of breast cancer diagnosis and treatment in Shaanxi Province, providing valuable insights into the local practices and outcomes.
Methods: We selected...
Citations
... COVID-19 has brought unprecedented global health challenges, revealing insights into viral pathogenesis, immune responses, and the dynamics of viral mutations during transmission and spread. These mutations can alter the virus's transmissibility, virulence, and impact on disease severity, contributing to the emergence of new variants [31][32][33][34][35][36]. ...
COVID-19 has caused widespread morbidity and mortality, with its effects extending to multiple organ systems. Despite known risk factors for severe disease, including advanced age and underlying comorbidities, patient outcomes can vary significantly. This variability complicates efforts to predict disease progression and tailor treatment strategies. While diagnostic and therapeutic approaches are still under debate, RNA sequencing (RNAseq) has emerged as a promising tool to provide deeper insights into the pathophysiology of COVID-19 and guide personalized treatment. A comprehensive literature review was conducted using PubMed, Scopus, Web of Science, and Google Scholar. We employed Medical Subject Headings (MeSH) terms and relevant keywords to identify studies that explored the role of RNAseq in COVID-19 diagnostics, prognostics, and therapeutics. RNAseq has proven instrumental in identifying molecular biomarkers associated with disease severity in patients with COVID-19. It allows for the differentiation between asymptomatic and symptomatic individuals and sheds light on the immune response mechanisms that contribute to disease progression. In critically ill patients, RNAseq has been crucial for identifying key genes that may predict patient outcomes, guiding therapeutic decisions, and assessing the long-term effects of the virus. Additionally, RNAseq has helped in understanding the persistence of viral RNA after recovery, offering new insights into the management of post-acute sequelae, including long COVID. RNA sequencing significantly improves COVID-19 management, particularly for critically ill patients, by enhancing diagnostic accuracy, personalizing treatment, and predicting therapeutic responses. It refines patient stratification, improving outcomes, and holds promise for targeted interventions in both acute and long COVID.
... Most studies have found a negative association between lockdown restrictions and breast cancer care, including challenges in accessing healthcare, 14 increased prescription of preoperative endocrine therapy, 15 and even delayed surgery beyond 12 weeks. 16,17 The Brazilian national guidelines for early breast cancer detection, established in 2004 by the Brazilian National Cancer Institute (INCA), were updated in 2015 and currently recommend that all women aged 50-69 years undergo mammography screening every 2 years. 18 Early detection plays a crucial role in reducing mortality and the intensity of required treatment. ...
Objectives
The objective of this study was to assess the impact of the COVID-19 pandemic, after 2 years, on mammographic screening in Brazil evaluating BIRADS® results, breast cancer diagnosis rates, and breast cancer stage.
Study Design
This was an ecological observational study based on retrospective data from Brazil’s mammographic screening program from 2015 to 2023.
Methods
Data were obtained from the national screening database DATASUS – SISCAN (Cancer System Information) and retrieved in March 2024. Inclusion criteria comprised completeness of mammogram data (incomplete records were excluded), female participants aged 50 to 69 years, and mammograms exclusively performed for screening purposes. The study analyzed the number of mammograms conducted during the specified period, focusing on BIRADS® test results.
Results
Out of 23,851,371 mammograms performed between 2015 and 2023, 15,000,628 were included for analysis. A significant reduction of 39.6% in mammograms was observed in 2020 compared to 2019, followed by a 12.6% decrease in 2021. Notably, a substantial rise in BIRADS categories 4 and 5 examinations was seen post-pandemic. Breast cancer staging analysis revealed a shift towards more advanced stages (III and IV) diagnosed post-pandemic, suggesting potential delays in detection and diagnosis.
Conclusions
In conclusion, the study highlighted significant discrepancies in mammographic screenings and breast cancer diagnosis rates over 9 years. The pandemic reflected significant influence on the timing and stage at diagnosis, suggesting potential delays in detection and diagnosis that resulted in later identification of more advanced disease stages.
... 1,2 As a result, elective surgical procedures (including rectal cancer surgery) have been greatly reduced to ensure sufficient treatment capacity for COVID-19 patients and to reduce the burden on intensive care units during period of high COVID-19 caseloads. [3][4][5] Several expert committees have issued guidelines recommending to postpone non-urgent cancer surgery. It has been suggested to prefer open surgery over laparoscopic/robotic surgery because of concerns about the increased risk of aerosol spread of coronavirus 2(SARS-CoV-2) during the laparoscopic/robotic surgery. ...
Introduction
The management of patients with COVID-19 infection has placed great pressure on the healthcare systems around the world. The aim of this study was to investigate the impact of the COVID-19 pandemic on the treatment outcomes of patients with rectal cancer by comparing them to those of patients with the same diagnosis in the pre-pandemic period.
Methods
Retrospective data analysis of patients undergoing multimodal treatment for rectal cancer at the four university hospitals during the COVID-19 pandemic (2020–2021) and the 2-year pre-pandemic period (2018–2019).
Results
A total of 693 patients (319 in the pre-pandemic period and 374 in the pandemic period) with rectal cancer were included in the study. The demographic and clinical characteristics of patients in both study periods were comparable, as was the spectrum of surgical procedures. Palliative surgery was more common in the pandemic period (18% vs 13%, p=0.084). The proportion of patients undergoing minimally invasive surgery was higher during the COVID-19 pandemic (p=0.025). There were no statistically significant differences between the study periods in the incidence/severity of post-operative complications, 30-day mortality and length of hospital stay. The number of positive resection margins was similar (5% vs 5%). Based on these results, COVID-19 had no effect on the postoperative morbidity and mortality in patients undergoing surgery for rectal cancer. Neoadjuvant treatment was more common in the pre-pandemic period (50% vs 45%). Long-course RT was predominantly offered in the pre-pandemic period, short-course RT during the pandemic. Significantly shorter “diagnosis-surgery” intervals were observed during the pandemic (23 days vs 33 days, p=0.0002). The “surgery-adjuvant therapy” interval was similar in both analysed study periods (p=0.219).
Conclusion
Our study showed, that despite concerns about the COVID-19 pandemic, multimodal treatment of rectal cancer was associated with unchanged postoperative morbidity rates, increased frequency of short-course neoadjuvant RT administration and shorter “diagnosis-surgery” intervals.
... However, the magnitude of the effects depend strongly on the type of cancer and the lag time intervals measured in the cancer care continuum [3,10]. To some extent, planned cancer surgery was sensitive to the stringency of the pandemic lockdown (i.e., light or moderate restrictions and full lockdowns), as reported in different income country group levels [11]. ...
Background
Longer times between diagnosis and treatments of cancer patients have been estimated as effects of the COVID-19 pandemic. However, relatively few studies attempted to estimate actual delay to treatment at the patient level.
Objective
To assess changes in delays to first treatment and surgery among newly diagnosed patients with localized breast cancer (BC) during the COVID-19 pandemic.
Methods
We used data from the PAPESCO-19 multicenter cohort study, which included patients from 4 French comprehensive cancer centers. We measured the delay to first treatment as the number of days between diagnosis and the first treatment regardless of whether this was neoadjuvant chemotherapy or surgery. COVID-19 pandemic exposure was estimated with a composite index that considered both the severity of the pandemic and the level of lockdown restrictions. We ran generalized linear models with a log link function and a gamma distribution to model the association between delay and the pandemic.
Results
Of the 187 patients included in the analysis, the median delay to first treatment was 42 (IQR:32–54) days for patients diagnosed before and after the start of the 1st lockdown (N = 99 and 88, respectively). After adjusting for age and centers of inclusion, a higher composite pandemic index (> = 50 V.S. <50) had only a small, non-significant effect on times to treatment. Longer delays were associated with factors other than the COVID-19 pandemic.
Conclusion
We found evidence of no direct impact of the pandemic on the actual delay to treatment among patients with localized BC.
... 7,8,25 Previous data revealed higher therapeutic delay in rectal cancer than in colon cancer. 26 Previous studies showed different situations regarding the recovery of activity after the lockdown phase of the SARS-CoV-2 pandemic. In some places, the activity came back to almost normal more quickly than in others. ...
Background and Study Aims
Our aim was to determine the impact of the SARS‐CoV‐2 pandemic on the diagnosis and prognosis of colorectal cancer (CRC).
Patients and Methods
This prospective cohort study included individuals diagnosed with CRC between March 13, 2019 and June 20, 2021 across 21 Spanish hospitals. Two time periods were compared: prepandemic (from March 13, 2019 to March 13, 2020) and pandemic (from March 14, 2020 to June 20, 2021, lockdown period and 1 year after lockdown).
Results
We observed a 46.9% decrease in the number of CRC diagnoses (95% confidence interval (CI): 45.1%–48.7%) during the lockdown and 29.7% decrease (95% CI: 28.1%–31.4%) in the year after the lockdown. The proportion of patients diagnosed at stage I significantly decreased during the pandemic (21.7% vs. 19.0%; p = 0.025). Centers that applied universal preprocedure SARS‐CoV‐2 PCR testing experienced a higher reduction in the number of colonoscopies performed during the pandemic post‐lockdown (34.0% reduction; 95% CI: 33.6%–34.4% vs. 13.7; 95% CI: 13.4%–13.9%) and in the number of CRCs diagnosed (34.1% reduction; 95% CI: 31.4%–36.8% vs. 26.7%; 95% CI: 24.6%–28.8%). Curative treatment was received by 87.5% of patients diagnosed with rectal cancer prepandemic and 80.7% of patients during the pandemic post‐lockdown period ( p = 0.002).
Conclusions
The COVID‐19 pandemic has led to a decrease in the number of diagnosed CRC cases and in the proportion of stage I CRC. The reduction in the number of colonoscopies and CRC diagnoses was higher in centers that applied universal SARS‐CoV‐2 PCR screening before colonoscopy. In addition, the COVID‐19 pandemic has affected curative treatment of rectal cancers.
... During the first lockdown from March to July 2020, reduction in demand was related to a significant drop in trauma, elective and semi-elective surgery, and delays in performing non-urgent stem cell transplants, similar reductions in demand were also reported by others. [20][21][22][23] The NHSBT Hospital and Science website (https:// hospi tal. blood. ...
The supply of blood components and products in sufficient quantities is key to any effective health care system. This report describes the challenges faced by the English blood service, NHS Blood and Transplant (NHSBT), towards the end of the COVID‐19 pandemic, which in October 2022 led to an Amber Alert being declared to hospitals indicating an impending blood shortage. The impact on the hospital transfusion services and clinical users is explained. The actions taken by NHSBT to mitigate the blood supply challenges and ensure equity of transfusion support for hospitals in England including revisions to the national blood shortage plans are described. This report focuses on the collaboration and communication between NHSBT, NHS England (NHSE), Department of Health and Social Care (DHSC), National Blood Transfusion Committee (NBTC), National Transfusion Laboratory Managers Advisory Group for NBTC (NTLM), National Transfusion Practitioners Network, the medical Royal Colleges and clinical colleagues across the NHS.
... During the COVID-19 pandemic, the resources, and the attention in healthcare systems globally, shifted towards preventing and managing COVID-19 [1,2]. Access to the non-COVID-19-related healthcare services changed [3], waiting times increased [4], and cancer pathways including treatment standards were adapted [5][6][7][8]. In addition, patients' healthcare-seeking behaviour changed as people adopted social distancing (limiting face-to-face contact) and shielding (safeguarding high-risk people) to protect themselves and others from an infection, and healthcare systems from the unprecedented pressures of the pandemic [9]. ...
... In addition, patients' healthcare-seeking behaviour changed as people adopted social distancing (limiting face-to-face contact) and shielding (safeguarding high-risk people) to protect themselves and others from an infection, and healthcare systems from the unprecedented pressures of the pandemic [9]. This resulted in a widespread negative effect of the COVID-19 pandemic on cancer care including delays and missed opportunities in diagnoses and treatments [4][5][6][7][8]10,11]. The extent to which Original Article this will affect health and survival of patients is not yet fully understood. ...
Objectives
To investigate the effect of the COVID‐19 pandemic on prostate cancer incidence, prevalence, and mortality in England.
Patients and Methods
With the approval of NHS England and using the OpenSAFELY‐TPP dataset of 24 million patients, we undertook a cohort study of men diagnosed with prostate cancer. We visualised monthly rates in prostate cancer incidence, prevalence, and mortality per 100 000 adult men from January 2015 to July 2023. To assess the effect of the pandemic, we used generalised linear models and the pre‐pandemic data to predict the expected rates from March 2020 as if the pandemic had not occurred. The 95% confidence intervals (CIs) of the predicted values were used to estimate the significance of the difference between the predicted and observed rates.
Results
In 2020, there was a drop in recorded incidence by 4772 (31%) cases (15 550 vs 20 322; 95% CI 19 241–21 403). In 2021, the incidence started to recover, and the drop was 3148 cases (18%, 17 950 vs 21 098; 95% CI 19 740–22 456). By 2022, the incidence returned to the levels that would be expected. During the pandemic, the age at diagnosis shifted towards older men. In 2020, the average age was 71.6 (95% CI 71.5–71.8) years, in 2021 it was 71.8 (95% CI 71.7–72.0) years as compared to 71.3 (95% CI 71.1–71.4) years in 2019.
Conclusions
Given that our dataset represents 40% of the population, we estimate that proportionally the pandemic led to 20 000 missed prostate cancer diagnoses in England alone. The increase in incidence recorded in 2023 was not enough to account for the missed cases. The prevalence of prostate cancer remained lower throughout the pandemic than expected. As the recovery efforts continue, healthcare should focus on finding the men who were affected. The research should focus on investigating the potential harms to men diagnosed at older age.
... In selected areas, the rapid increase of COVID-19 patients requiring hospitalisation overburdened acute healthcare systems, including intensive care units (ICUs), as seen in northern Italy, Madrid and New York [1][2][3]. Even in less affected jurisdictions, the anticipation of a potential surge in ICU admissions and the diversion of human resources forced government and healthcare administrators to transiently limit elective interventional and outpatient activity [4][5][6]. Interestingly, while some districts had to expand ICU capabilities to meet the need for ICU beds, the incidence of some acute conditions routinely managed in ICUs (e.g. acute coronary syndrome, intracranial haemorrhage, stroke and major trauma) declined drastically during the first wave of the pandemic [7][8][9][10][11], leading to an overflow of vacant ICU beds in other regions. ...
... In general, about 10% of patients with several solid cancer types did not receive their planned surgical treatment, and those awaiting surgery in a complete lockdown for more than six weeks had an increased likelihood of non-operation. The effect of these changes in therapeutic approach on outcomes has not been reported [5]. In situations with several treatment options (e.g. ...
BACKGROUND AND AIM: The coronavirus disease 2019 (COVID-19) outbreak deeply affected intensive care units (ICUs). We aimed to explore the main changes in the distribution and characteristics of Swiss ICU patients during the first two COVID-19 waves and to relate these figures with those of the preceding two years. METHODS: Using the national ICU registry, we conducted an exploratory study to assess the number of ICU admissions in Switzerland and their changes over time, characteristics of the admissions, the length of stay (LOS) and its trend over time, ICU mortality and changes in therapeutic nursing workload and hospital resources in 2020 and compare them with the average figures in 2018 and 2019. RESULTS: After analysing 242,935 patient records from all 84 certified Swiss ICUs, we found a significant decrease in admissions (–9.6%, corresponding to –8005 patients) in 2020 compared to 2018/2019, with an increase in the proportion of men admitted (61.3% vs 59.6%; p <0.001). This reduction occurred in all Swiss regions except Ticino. Planned admissions decreased from 25,020 to 22,021 in 2020 and mainly affected the neurological/neurosurgical (–14.9%), gastrointestinal (–13.9%) and cardiovascular (–9.3%) pathologies. Unplanned admissions due to respiratory diagnoses increased by 1971 (+25.2%), and those of patients with acute respiratory distress syndrome (ARDS) requiring isolation reached 9973 (+109.9%). The LOS increased by 20.8% from 2.55 ± 4.92 days (median 1.05) in 2018/2019 to 3.08 ± 5.87 days (median 1.11 days; p <0.001), resulting in an additional 19,753 inpatient days. The nine equivalents of nursing manpower use score (NEMS) of the first nursing shift (21.6 ± 9.0 vs 20.8 ± 9.4; p <0.001), the total NEMS per patient (251.0 ± 526.8 vs 198.9 ± 413.8; p <0.01) and mortality (5.7% vs 4.7%; p <0.001) increased in 2020. The number of ICU beds increased from 979 to 1012 (+3.4%), as did the number of beds equipped with mechanical ventilators (from 773 to 821; +6.2%). CONCLUSIONS: Based on a comprehensive national data set, our report describes the profound changes triggered by COVID-19 over one year in Swiss ICUs. We observed an overall decrease in admissions and a shift in admission types, with fewer planned hospitalisations, suggesting the loss of approximately 3000 elective interventions. We found a substantial increase in unplanned admissions due to respiratory diagnoses, a doubling of ARDS cases requiring isolation, an increase in ICU LOS associated with substantial nationwide growth in ICU days, an augmented need for life-sustaining therapies and specific therapeutic resources and worse outcomes.
... The impact of COVID-19 on elements of the cancer pathway and for specific tumour sites have been reported, but this is the first to study reveal the stark, adverse impact of COVID-19 on the entire cancer patient journey, from initial presentation and diagnosis through to treatment and survival, at a population level and for all tumour sites. [9][10][11][12][13][30][31][32] Overall, there was a 13% (almost 1000) reduction in new (incident) cancer cases with variations by tumour type, ranging from reductions of 39% for melanoma to 3.6% for stomach cancer and reductions of 7.5% for lung, 11% for female breast, 12% for colorectal and 14.5% for prostate cancer, respectively. In the prepandemic period cancer cases had risen steadily in NI and were projected to continue increasing, so the reduction in cancer cases was unprecedented and shows the profound impact of COVID on cancer diagnoses. ...
The COVID‐19 pandemic had a major impact on cancer patients and services but has been difficult to quantify. We examined how the entire cancer pathway—from incidence, presentation, diagnosis, stage, treatment and survival—was affected in Northern Ireland during April–December 2020 compared to equivalent 2018–2019 periods using retrospective, observational cancer registry data from the Northern Ireland Cancer Registry (NICR). There were 6748 cancer cases in April–December 2020 and an average 7724 patients in April–December 2018–2019. Incident cases decreased by 13% (almost 1000). Significant differences were found across age cohorts and deprivation quintiles, with reductions greatest for younger people (<55 years; 19% decrease) and less deprived (22% decrease). A higher proportion had emergency admission (16%‐to‐20%) with lower proportions diagnosed pathologically (85%‐to‐83%). There was a significant stage shift, with lower proportions of early stage (29%‐to‐25%) and higher late‐stage (21%‐to‐23%). Lower proportions received surgery (41%‐to‐38%) and radiotherapy (24%‐to‐22%) with a higher proportion not receiving treatment (29%‐to‐33%). One‐year observed‐survival decreased from 73.7% to 69.8% and 1‐year net‐survival decreased from 76.1% to 72.9%, with differences driven by five tumours; Lung (40.3%‐to‐35.0%), Head‐and‐Neck (77.4%‐to‐68.4%), Oesophageal (53.5%‐to‐42.3%), Lymphoma (81.1%‐to‐75.2%) and Uterine cancer (87.4%‐to‐80.4%). Our study reveals profound adverse impact of COVID‐19 on the entire cancer patient pathway, with 13% fewer cases, greater emergency admissions and significant stage‐shift from early to more advanced‐stage disease. There was major treatment impact with lower rates of surgery and radiotherapy and higher proportions receiving no treatment. There were significant reductions in 1‐year survival. Our study will support service recovery and protect cancer services in future pandemics or disruptions.
... The literature reports a few studies on breast (26) and lung (27) cCPs, showing that CPs provided continuity of care, despite the significant pandemic-driven disruption. On the other hand, findings from more comprehensive studies outlined that further public health efforts are still needed to deal with the impact of the pandemic on delivery of cancer care regarding issues ranging from screening to follow-up (28)(29)(30). As a matter of fact, since the pandemic consequences are still affecting the functioning of health care systems and considering that care delivery has been deeply reorganized locally and worldwide, we believe that studying the impact of COVID-19 and that of its responding strategies is currently worthwhile in order to plan future health care services. ...
The COVID-19 pandemic burdened health care systems worldwide. Health services were reorganized with the dual purpose of ensuring the most adequate continuity of care and, simultaneously, the safety of patients and health professionals. The provision of care to patients within cancer care pathways (cCPs) was not touched by such reorganization. We investigated whether the quality of care provided by a local comprehensive cancer center has been maintained using cCP indicators. A retrospective single-cancer center study was conducted on eleven cCPs from 2019 to 2021 by comparing three timeliness indicators, five care indicators and three outcome indicators yearly calculated on incident cases. Comparisons of indicators between 2019 and 2020, and 2019 and 2021, were performed to assess the performance of cCP function during the pandemic. Indicators displayed heterogeneous significant changes attributed to all cCPs over the study period, affecting eight (72%), seven (63%) and ten (91%) out of eleven cCPs in the comparison between 2019 and 2020, 2020 and 2021, and 2019 and 2021, respectively. The most relevant changes were attributed to a negative increase in time-to-treatment surgery-related indicators and to a positive increase in the number of cases discussed by cCP team members. No variations were found attributed to outcome indicators. Significant changes did not account for clinical relevance once discussed by cCP managers and team members. Our experience demonstrated that the CP model constitutes an appropriate tool for providing high levels of quality care, even in the most critical health situations.
