De Souza Shuell, Kahol de Jong Jeffrey, Perone Ylenia, Shetty Shishir, Qurashi Maria, Vithayathil Mathew, Shah Tahir, Ross Paul, Temperley Laura, Yip Vincent S, Banerjee Abhirup, Bettinger Dominik, Sturm Lukas, Reeves Helen L, Geh Daniel, Orr James, Allen Benjamin, Jones Robert P, Sharma Rohini
Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, London W12 0NN, UK.
National Institute for Health Research Birmingham Liver Biomedical Research Unit and Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK.
Cancers (Basel). 2023 Jun 27;15(13):3378. doi: 10.3390/cancers15133378.
The COVID-19 pandemic has caused severe disruption of healthcare services worldwide and interrupted patients' access to essential services. During the first lockdown, many healthcare services were shut to all but emergencies. In this study, we aimed to determine the immediate and long-term indirect impact of COVID-19 health services utilisation on hepatocellular cancer (HCC) outcomes.
A prospective cohort study was conducted from 1 March 2020 until 30 June 2020, correlating to the first wave of the COVID-19 pandemic. Patients were enrolled from tertiary hospitals in the UK and Germany with dedicated HCC management services. All patients with current or past HCC who were discussed at a multidisciplinary meeting (MDM) were identified. Any delay to treatment (DTT) and the effect on survival at one year were reported.
The median time to receipt of therapy following MDM discussion was 49 days. Patients with Barcelona Clinic Liver Cancer (BCLC) stages-A/B disease were more likely to experience DTT. Significant delays across all treatments for HCC were observed, but delay was most marked for those undergoing curative therapies. Even though severe delays were observed in curative HCC treatments, this did not translate into reduced survival in patients.
Interruption of routine healthcare services because of the COVID-19 pandemic caused severe delays in HCC treatment. However, DTT did not translate to reduced survival. Longer follow is important given the delay in therapy in those receiving curative therapy.
新冠疫情已在全球范围内造成医疗服务的严重中断，并干扰了患者获得基本医疗服务的机会。在首次封锁期间，除急诊外，许多医疗服务都停止了。在本研究中，我们旨在确定新冠疫情期间医疗服务利用情况对肝细胞癌（HCC）预后的短期和长期间接影响。
于2020年3月1日至2020年6月30日进行了一项前瞻性队列研究，这与新冠疫情的第一波疫情相关。研究对象来自英国和德国设有专门HCC管理服务的三级医院。确定了所有在多学科会议（MDM）上讨论过的现患或既往患HCC的患者。报告了任何治疗延迟情况（DTT）以及对一年生存率的影响。
MDM讨论后接受治疗的中位时间为49天。巴塞罗那临床肝癌（BCLC）分期为A/B期的患者更有可能经历治疗延迟。观察到所有HCC治疗均出现显著延迟，但根治性治疗的延迟最为明显。尽管根治性HCC治疗出现了严重延迟，但这并未导致患者生存率降低。
新冠疫情导致的常规医疗服务中断致使HCC治疗出现严重延迟。然而，治疗延迟并未导致生存率降低。鉴于接受根治性治疗的患者治疗出现延迟，更长时间的随访很重要。
