Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK.
Chron Respir Dis. 2023 Jan-Dec;20:14799731231157770. doi: 10.1177/14799731231157770.
: This study retrospectively analyses the impact of the 1 year of the COVID-19 pandemic on route of presentation and staging in lung cancer compared to the 2 years before and after implementation of the Leicester Optimal Lung Cancer Pathway (LOLCP) in Leicester, United Kingdom. : Electronic databases and hospital records were used to identify all patients diagnosed with lung cancer in 2018 (pre-LOLCP), 2019 (post-LOLCP), and March 2020-2021 (post-COVID-19 lockdown). Information regarding patient characteristics, performance status, stage, and route of diagnosis was documented and analysed. Emergency presentation was defined as diagnosis of new lung cancer being made after unscheduled attendance to urgent or emergency care facility. : Following implementation of the LOLCP pathway, there was a significant decrease in emergency presentations from 26.8 to 19.6% ( = 0.002) with a stage shift from 33.9% early stage disease to 40.3%. These improved outcomes were annulled during the COVID-19 pandemic, with emergency presentations increasing to 38.9% ( < 0.001) and a reduction in early-stage lung cancer diagnoses to 31.5%. There was a 61% decline in 2 week wait referrals but no significant decline in the LOLCP direct-to-CT referrals. : We have demonstrated a significant increase in late-stage lung cancer diagnoses and emergency presentations during the first year of the COVID-19 pandemic. The causes for these changes are likely to be multifactorial. The long-term effect on lung cancer mortality remains to be seen and is an important focus of future study.
本研究回顾性分析了 COVID-19 大流行对英国莱斯特实施莱斯特最优肺癌路径（LOLCP）前后 2 年与肺癌就诊途径和分期的影响。使用电子数据库和医院记录，确定了 2018 年（LOLCP 之前）、2019 年（LOLCP 之后）和 2020 年 3 月至 2021 年（COVID-19 封锁后）所有确诊为肺癌的患者。记录并分析了患者特征、表现状态、分期和诊断途径。急诊就诊被定义为在非计划就诊于紧急或急诊医疗机构后确诊为新发肺癌。 LOLCP 途径实施后，急诊就诊率从 26.8%降至 19.6%（=0.002），早期疾病分期从 33.9%转为 40.3%。这些改善的结果在 COVID-19 大流行期间被否定，急诊就诊率上升至 38.9%（<0.001），早期肺癌诊断减少至 31.5%。2 周候诊转诊下降了 61%，但 LOLCP 直接 CT 转诊没有明显下降。我们发现 COVID-19 大流行第一年晚期肺癌诊断和急诊就诊显著增加。这些变化的原因可能是多方面的。对肺癌死亡率的长期影响仍有待观察，这是未来研究的一个重要重点。
