Mortality for high-risk gastrointestinal cancers ‘largely unaffected’ by COVID-19 pandemic
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Key takeaways :
- High-risk gastrointestinal cancer diagnoses decreased during the first 3 months of the pandemic but returned to prepandemic levels by the middle of 2020.
- No significant difference of 1-year survival occurred.
High-risk gastrointestinal cancer diagnoses declined sharply during the first 3 months of the COVID-19 pandemic in 2020, but they returned to previous levels by the middle of the year, according to results published in JAMA Network Open.
Additionally, 1-year survival rates remained relatively unchanged in 2020 compared with 2018 and 2019.
“We suspect that the long-term survival outcomes among this cohort of patients will remain largely unaffected by the pandemic as 1-year survival curves in 2020 mirrored those of prior years,” Lauren M. Janczewski, MD, research fellow at Northwestern University, told Healio.
Background and methodology
Healio previously reported more than 130,000 cancer cases went undiagnosed during the first 10 months of the pandemic.
High-risk gastrointestinal cancers are often diagnosed at advanced stages and can lead to worse survival, according to background information provided by researchers.
“Early reports during the pandemic identified that patients who contracted COVID-19 shortly before or after surgery were at increased risk for experiencing a postoperative mortality, leading many societies to release consensus statements regarding the delay of elective or semi-elective procedures, often including operations for cancer,” Janczewski said. “However, for certain cancer sites that are often characterized by a more aggressive disease course, delays in their necessary cancer operations could lead to worse long-term survival.
“Thus, we felt it critical to examine both the operative mortality and 1-year overall survival on a national scale for patients diagnosed with high-risk gastrointestinal malignancies,” she added.
Janczewski and colleagues used the National Cancer Database to identify individuals diagnosed with high-risk gastrointestinal cancer (esophageal, gastric, primary liver and pancreatic cancers) between Jan. 1, 2018, and Dec. 31, 2020, for their retrospective study.
Patients had to be at least 18 years old and have just one primary cancer diagnosis in their lifetime to be included.
The study cohort consisted of 156,937 patients (35% aged between 60 and 69 years; 63.8% men; 71.9% white, 13.2% Black, 9.8% Hispanic, 5.1% Asian).
Researchers evaluated the impact of COVID-19 on newly diagnosed cases, stage at diagnosis and mortality compared with the previous 2 years.
Results and next steps
The year 2020 had the fewest diagnoses (32.3%) compared with 33.2% in 2018 and 34.5% in 2019.
During the opening 3 months of the pandemic (March-May 2020), at least 3,000 fewer cases had been diagnosed compared with the previous 2 years, with roughly half of the deficit occurring in April (P = .002).
However, diagnoses normalized by July and no significant difference could be ascertained between the remaining months of 2020 and the previous 2 years.
“We were surprised that no rebound effect was identified later on in 2020, as we initially expected the cases that went undiagnosed at the onset of the pandemic would have been captured later on in the year,” Janczewski said.
In the first 3 months of the pandemic, the number of stage IV diagnoses increased compared with the same time frames in 2018 and 2019, and the amount of stage I and stage II diagnoses decreased, but those rates also returned to normal by the middle of the year.
The 1-year OS rate for individuals diagnosed in 2020 dropped by 3% compared with the previous 2 years (47.4% vs. 50.7%; P < .001), but patients did not have a higher likelihood of death (HR = 0.99; 95% CI, 0.97-1.01).
“We also found this surprising,” Janczewski said.
She noted the importance of investigating other cancer sites as more data surfaces on long-term outcomes.
“Overall, this is a tribute to all of the cancer providers at the time, who advocated on behalf of their patients in the face of one of the deadliest pandemics in history to ensure that those who were able to be diagnosed received the treatment they needed,” Janczewski said.
For more information:
Lauren M. Janczewski, MD, can be reached at lauren.janczewski1@nm.org.
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