Impact of the COVID-19 pandemic on lung cancer diagnosis, treatment, mortality, and survival in Belgium: A population-based study

Abstract

Background

We evaluated the impact of COVID-19 on the care pathway and outcomes for patients diagnosed with lung cancer in 2020 in Belgium.

Methods

Lung cancer patients diagnosed in 2017–2020 were extracted from the nationwide Belgian Cancer Registry database. Characteristics and treatment of patients in 2020 were compared with 2017–2019 at semester level (January-June: S1; July-December: S2). 90-day post-operative mortality and relative survival (RS) at 1 and 3 years for 2020 were compared with the 2017–2019 trend.

Results

The study included 29,721 patients diagnosed with lung cancer in 2017–2020. Patients diagnosed in 2020 had a poorer WHO Performance status and more often distant metastases compared to the corresponding semester in 2017–2019. In 2020 S2, there was slightly less surgery performed in patients with early-stage (I-II) lung cancer in favour of radiotherapy (RT) (surgery:4.7 percent-points, RT +6.0 percent-points, p = 0.001). RT courses had a shorter median duration (S1:4 days; S2:4 days) and lower median number of fractions (S1:5; S2:5). The unadjusted 90-day post-operative mortality increased, but this increase was no longer significant when adjusting for case-mix (unadjusted: Odds ratio (OR) =1.85 [1.05–3.24]; adjusted: (OR 1.78 [0.99–3.21]). There was no significant change in RS at 1 and 3 years, with or without case-mix adjustment (unadjusted: 1-year excess hazard ratio (EHR)=1.06 [1.00–1.12], 3-year EHR=1.05 [1.00–1.11]; adjusted: 1-year EHR=1.02 [0.96–1.08], 3-year EHR=1.02 [0.96–1.07]).

Conclusion

Lung cancer patients in Belgium experienced only minor changes in their care pathway during the COVID-19 pandemic. The changes in stage distribution and the increase in 90-day postoperative mortality warrant monitoring of long-term outcomes.