Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2022

The impact of the early COVID-19 pandemic on time to presentation and diagnosis of lung cancer (#79)

Rebecca J Bergin 1 2 , Dallas English 1 3 , Roger Milne 1 3 4 , Victoria White 5 6
  1. Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia
  2. Department of General Practice and Centre for Cancer Research, University of Melbourne, Melbourne, VIC, Australia
  3. Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
  4. Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
  5. Behavioural Science Division, Cancer Council Victoria, Melbourne, VIC, Australia
  6. School of Psychology, Deakin University, Melbourne, VIC, Australia

Aims: COVID-19 may have delayed cancer diagnoses. We compared times from first symptom to presentation, diagnosis and treatment of lung cancer before and during the pandemic, and patient and general practitioner (GP) responses to COVID-19.

Methods:  Questionnaires were mailed to Victorian patients with primary lung cancer (n=218, response 34%) diagnosed within the previous six-months (Nov 2018–Nov 2020, 89% had surgery, 72% stage I/II). Their GPs were also sent questionnaires (n=140, response 69%). Fifty-four patients were diagnosed from April 2020 (COVID-19 period); 47 patients and 25 GPs completed COVID-19-specific questionnaires. Interviews were conducted with six patients diagnosed in June/July 2020. Diagnostic route and timeliness of care before and during COVID-19 were compared using Chi-squared and Fisher’s exact tests. Content analysis was applied to interview data.

Results: Routes to diagnosis were similar for those diagnosed before and during COVID-19 (77% and 65% via symptoms to GP, respectively, p=0.31). Median time from first symptom to presentation was marginally shorter after COVID-19, 17 vs 23 days (P=0.08). Time from presentation to diagnosis and treatment did not differ.

During COVID-19, few patients had telehealth for initial appointments (5% GP, 11.5% specialist appointments). Almost all (98%) reported no delays due to COVID-19. Similarly, 79% of GPs reported no impact of COVID-19 on their patient’s diagnostic pathway. However, more broadly, 33% of GPs ordered fewer blood tests and imaging, saw fewer patients, and 72% perceived waiting longer for specialist/hospital appointments post-COVID-19; with most (74%) reporting increased use of telehealth.

In interviews, patients’ greatest difficulties were related to hospital experiences, particularly not being allowed visitors.

Conclusions: For lung cancer, we found no adverse impact of COVID-19 on timeliness of diagnosis and treatment, and presentation may have been quicker. Telehealth use for lung cancer patients was limited, though more general changes in GP practice due to COVID-19 were evident.