COVID-19 and liver cancer: lost patients and larger tumors
This article was originally published here
BMJ Open Gastroenterol. 2022 Apr;9(1):e000794. doi: 10.1136/bmjgast-2021-000794.
BACKGROUND: The North of England has seen a persistent rise in the number of primary liver cancers, largely due to an increasing incidence of hepatocellular carcinoma (HCC) secondary to alcohol-related liver disease and fatty liver disease non-alcoholic hepatic. Here we review the effect of the COVID-19 pandemic on primary liver cancer treatment services and patients in our region.
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 during the first year of the pandemic (March 2020-February 2021), comparing mode of presentation, disease stage, treatments, and outcomes to a consecutive retrospective observational cohort immediately pre-pandemic (March 2019-February 2020).
RESULTS: We observed a marked decrease in HCC referrals compared to previous years, from 190 new confirmed cases to 120 (37%). The symptomatic mode of presentation has become the most common mode of presentation, with fewer tumors detected by surveillance or accidentally (% surveillance/accidental/symptomatic; 34/42/24 pre-pandemic vs 27/33/40 during the pandemic, p= 0.013). HCC tumor 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 tumor hemorrhage. The number of new cases of intrahepatic cholangiocarcinoma (ICC) decreased only slightly, with a typical symptomatic presentation. Patients received treatment appropriate to their stage of cancer, with shorter waiting times for patients with HCC and unchanged for patients with CCI. Survival was associated with stage before and during the pandemic. 9% contracted a COVID-19 infection.
CONCLUSION: The reduction in the number of referred patients associated with the pandemic in our region has been attributed to the disruption of routine health care. For the people referred, the treatments and the survival were adapted to their stage during the presentation. Unreferred or missing patients are expected to have more advanced disease, with poorer outcomes. Although protective measures are necessary during the pandemic, we recommend that routine health services continue, with patients encouraged to engage.