The impact of the COVID-19 pandemic on lung cancer presentation at a high-volume tertiary referral centre in South Africa

Abstract

Background: The COVID-19 pandemic had a significant impact on health services globally. Cancer diagnosis and treatment was one of the services most frequently reported to be disrupted. Several international studies showed a marked reduction in the number of new lung cancer cases.

Objectives: To assess the impact of the COVID-19 pandemic on lung cancer diagnosis at a high-volume tertiary referral centre in South Africa.

Methods: A retrospective audit was conducted of all patients with primary lung cancer who were presented at the multidisciplinary oncology meeting at Tygerberg Hospital, Cape Town, from January 2018 to December 2021, and the incidence of lung cancer was compared between two cohorts: one prior to and one during the COVID-19 pandemic. We collected data on patient demographics, as well as performance status. A combined panel staged all patients.

Results: During the COVID-19 pandemic there was a relative reduction of 46% in the frequency of lung cancer, from a mean of 25.6 cases per month to 13.9. Patients referred during the COVID-19 pandemic had statistically better performance status (75.0% v. 25.0% with performance status 0 - 2; p=0.01) and were more likely to have adenocarcinoma (49.7% v. 41.1%; p=0.02) than those referred before the pandemic. The proportion of potentially curable lung cancer at presentation (i.e. stages I - IIIA) did not differ between the two cohorts.

Conclusion: The COVID-19 pandemic resulted in a substantial decrease in the number of new lung cancers diagnosed. Patients who were diagnosed with lung cancer during the pandemic had better performance status and were more likely to have adenocarcinoma. No impact on the proportion of potential curable disease was noted.

Study synopsis: What the study adds. Health services globally were substantially impacted by the COVID-19 pandemic. Cancer diagnosis and treatment was one of the services most frequently reported to be disrupted. This study highlights the significant impact of the COVID-19 pandemic on lung cancer presentation in a high-volume tertiary hospital in South Africa.Implications of the findings. Lung cancer is known to have high mortality. The reduction in lung cancer presentation during the COVID-19 pandemic is likely to result in an increase in lung cancer-related morbidity and mortality over the next few years.

Keywords: COVID-19; lung cancer; staging.