NHMRC Clinical Trials Centre, The University of Sydney, NSW, Australia.
School of Public Health, The University of Sydney, NSW, Australia.
Public Health Res Pract. 2024 Oct 23;34(3):3432423. doi: 10.17061/phrp3432423.
The coronavirus disease 2019 (COVID-19) pandemic disrupted healthcare systems worldwide, causing substantial changes to routine healthcare delivery. National and international modelling studies have predicted adverse impacts of this disruption. This study aimed to assess the real-world impact of the COVID-19 pandemic on quality of care and outcomes for patients with lung cancer in New South Wales (NSW).
Pre-post observational cohort study using data prospectively collected for the Embedding Research (and Evidence) in Cancer Healthcare (EnRICH) Program.
The study population comprised 2000 patients with lung cancer from six specialist cancer centres in metropolitan and regional NSW. We split this population into two cohorts: the pre-COVID-19 cohort (1143 patients diagnosed from 8 September 2016 to 10 March 2020) and the post-COVID-19 cohort (857 patients diagnosed from 11 March 2020 to 28 October 2021). The main outcome measures were lung cancer clinical quality indicators, 1-year and 2-year overall survival, and patient-reported health-related quality of life and psychological distress.
Patient and disease characteristics (e.g. age, gender, cancer stage) were similar for the pre-and post-COVID-19 cohorts, except for histology (non-small cell lung cancer (NSCLC) 88% in the pre-COVID-19 cohort and 84% in the post-COVID-19 cohort; p = 0.008) and region of residence (62% and 55%, respectively, lived in metropolitan areas; p = 0.002). Compared to the pre-COVID-19 cohort, fewer patients in the post-COVID-19 cohort received a diagnosis within 28 days of the first investigation of symptoms (clinical diagnosis: 77% compared with 72%; p = 0.017, pathological diagnosis: 60% compared with 53%; p = 0.005). However, the median time from the first investigation of symptoms to treatment initiation did not differ. One- and 2-year overall survival, quality of life and psychological distress did not differ between cohorts.
This analysis found that the COVID-19 pandemic did not significantly adversely affect quality of care and outcomes for patients with lung cancer in NSW. Reassuringly, these results suggest that prioritising urgent health services, such as cancer care and implementing protective mitigation measures were effective in avoiding the predicted adverse outcomes of healthcare service disruption.
2019 年冠状病毒病（COVID-19）大流行扰乱了全球的医疗体系，导致常规医疗服务发生了重大变化。国家和国际模型研究预测了这种中断的不利影响。本研究旨在评估 COVID-19 大流行对新南威尔士州（新州）肺癌患者的护理质量和结局的实际影响。
使用前瞻性收集的嵌入研究（和证据）在癌症保健（EnRICH）计划的数据进行的前后观察性队列研究。
研究人群包括来自新州大都市和地区的六家癌症中心的 2000 名肺癌患者。我们将该人群分为两个队列：COVID-19 前队列（1143 名于 2016 年 9 月 8 日至 2020 年 3 月 10 日确诊）和 COVID-19 后队列（857 名于 2020 年 3 月 11 日至 2021 年 10 月 28 日确诊）。主要结局指标是肺癌临床质量指标、1 年和 2 年总生存率以及患者报告的健康相关生活质量和心理困扰。
COVID-19 前后队列的患者和疾病特征（例如年龄、性别、癌症分期）相似，但组织学（非小细胞肺癌（NSCLC）COVID-19 前队列为 88%，COVID-19 后队列为 84%；p=0.008）和居住地（分别有 62%和 55%居住在大都市地区；p=0.002）不同。与 COVID-19 前队列相比，COVID-19 后队列中更少的患者在症状首次调查后 28 天内得到诊断（临床诊断：77%比 72%；p=0.017，病理诊断：60%比 53%；p=0.005）。然而，从症状首次调查到开始治疗的中位时间没有差异。1 年和 2 年总生存率、生活质量和心理困扰在队列之间没有差异。
本分析发现，COVID-19 大流行并未显著影响新州肺癌患者的护理质量和结局。令人安心的是，这些结果表明，优先考虑紧急卫生服务（如癌症护理）并实施保护缓解措施，对于避免医疗服务中断的预期不良后果是有效的。
