The Michener Institute/University of Toronto, Toronto, Canada; Department of Radiation Therapy, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada.
Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada.
Oral Oncol. 2023 Mar;138:106332. doi: 10.1016/j.oraloncology.2023.106332. Epub 2023 Feb 3.
We aim to assess the potential impact of the COVID-19 pandemic on diagnostic delays in HPV-positive oropharyngeal cancer (OPC), and to describe their underlying reasons.
All HPV + OPC referred to a tertiary cancer centre and diagnosed between June-December 2019 (Pre-Pandemic cohort) vs June-December 2020 (Pandemic cohort) were reviewed. TNM classification, gross-tumor-volumes (GTV) and intervals between sign/symptom onset and treatment initiation were compared between the cohorts. Reasons for delay (>6 months from onset of signs/symptoms to a positive biopsy of the primary tumor, or a delay specifically mentioned in the patient chart) in establishing the diagnosis were recorded per clinician's documentation, and categorized as COVID-related or non-COVID-related.
A total of 157 consecutive HPV + OPC patients were identified (Pre-Pandemic: 92; Pandemic: 65). Compared to the Pre-Pandemic cohort, Pandemic cohort patients had a higher proportion of N2-N3 (32 % vs 15 %, p = 0.019) and stage III (38 % vs 23 %, p = 0.034) disease at presentation. The differences in proportions with > 6 months delay from symptom onset to establishing the diagnosis (29 % vs 20 %, p = 0.16) or to first treatment (49 % vs 38 %, p = 0.22) were not statistically different. 47 % of diagnostic delays in the Pandemic cohort were potentially attributable to COVID-19.
We observed a collateral impact of the COVID-19 pandemic on HPV + OPC care through more advanced stage at presentation and a non-significant but numerically longer interval to diagnosis. This could adversely impact patient outcomes and future resource allocation. Both COVID-19-related and unrelated factors contribute to diagnostic delays. Tailored interventions to reduce delays are warranted.
我们旨在评估 COVID-19 大流行对 HPV 阳性口咽癌（OPC）诊断延迟的潜在影响，并描述其潜在原因。
回顾了所有于 2019 年 6 月至 12 月（大流行前队列）和 2020 年 6 月至 12 月（大流行队列）转诊至三级癌症中心并诊断为 HPV+OPC 的患者。比较了两组间 TNM 分期、大体肿瘤体积（GTV）和症状出现至治疗开始之间的时间间隔。根据临床医生的记录，记录了建立诊断的延迟（主要肿瘤的初次活检阳性的症状/体征出现后超过 6 个月，或患者病历中明确提到的延迟）的原因，并按 COVID 相关或非 COVID 相关进行分类。
共确定了 157 例连续的 HPV+OPC 患者（大流行前队列：92 例；大流行队列：65 例）。与大流行前队列相比，大流行队列患者在就诊时 N2-N3（32% vs 15%，p=0.019）和 III 期（38% vs 23%，p=0.034）疾病的比例更高。从症状出现到确诊（29% vs 20%，p=0.16）或首次治疗（49% vs 38%，p=0.22）的诊断延迟比例差异无统计学意义。大流行队列中 47%的诊断延迟可能归因于 COVID-19。
我们观察到 COVID-19 大流行通过更晚期的表现对 HPV+OPC 治疗产生了附带影响，且确诊和治疗的间隔时间虽然没有显著延长，但数值上有所延长。这可能会对患者的预后和未来的资源分配产生不利影响。COVID-19 相关和非相关因素都导致了诊断延迟。需要采取有针对性的干预措施来减少延迟。
