COVID-19 and liver cancer: lost patients and larger tumours.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Geh Daniel, Watson Robyn, Sen Gourab, French Jeremy J, Hammond John, Turner Paul, Hoare Tim, Anderson Kirsty, McNeil Michael, McPherson Stuart, Masson Steven, Dyson Jessica, Donnelly Mhairi, MacDougal Louise, Patel Preya, Hudson Mark, Anstee Quentin M, White Steven, Robinson Stuart, Pandanaboyana Sanjay, Walker Lucy, McCain Misti, Bury Yvonne, Raman Shreya, Burt Alastair, Parkinson Daniel, Haugk Beate, Darne Antony, Wadd Nick, Asghar Syed, Mariappan Lavanya, Margetts Jane, Stenberg Benjamin, Scott John, Littler Peter, Manas Derek M, Reeves Helen L
Аннотация
OBJECTIVE: To assess the impact of the COVID-19 pandemic on patients with newly diagnosed liver cancer in our region.
DESIGN: We prospectively audited our service for the first year of the pandemic (March 2020-February 2021), comparing mode of presentation, disease stage, treatments and outcomes to a retrospective observational consecutive cohort immediately prepandemic (March 2019-February 2020).
RESULTS: We observed a marked decrease in HCC referrals compared with previous years, falling from 190 confirmed new cases to 120 (37%). Symptomatic became the the most common mode of presentation, with fewer tumours detected by surveillance or incidentally (% surveillance/incidental/symptomatic; 34/42/24 prepandemic vs 27/33/40 in the pandemic, p=0.013). HCC tumour size was larger in the pandemic year (60±4.6 mm vs 48±2.6 mm, p=0.017), with a higher incidence of spontaneous tumour haemorrhage. The number of new cases of intrahepatic cholangiocarcinoma (ICC) fell only slightly, with symptomatic presentation typical. Patients received treatment appropriate for their cancer stage, with waiting times shorter for patients with HCC and unchanged for patients with ICC. Survival was associated with stage both before and during the pandemic. 9% acquired COVID-19 infection.
CONCLUSION: The pandemic-associated reduction in referred patients in our region was attributed to the disruption of routine healthcare. For those referred, treatments and survival were appropriate for their stage at presentation. Non-referred or missing patients are expected to present with more advanced disease, with poorer outcomes. While protective measures are necessary during the pandemic, we recommend routine healthcare services continue, with patients encouraged to engage.