Brunner Loïc, Nicolet Anna, Peytremann-Bridevaux Isabelle, Marti Joachim, Bulliard Jean-Luc, Righi Lorenzo, Britschgi Christian, Wicki Andreas, Bienvenu Christine, Ganz-Blaettler Ursula, Eicher Manuela, Michielin Olivier, Moschetti Karine, Le Pogam Marie-Annick
Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.
Medical Oncology and Hematology, Cantonal Hospital Winterthur, Winterthur, Switzerland.
BMC Cancer. 2025 Mar 15;25(1):477. doi: 10.1186/s12885-025-13818-5.
The COVID-19 pandemic exerted unprecedented pressure on healthcare systems worldwide, leading governments and hospitals to postpone elective procedures to prioritize care for COVID-19 patients. Cancer patients, who often require frequent interactions with hospital services, may have been disproportionately affected by these disuptions in healthcare delivery. This study aimed to analyze and compare hospital care provided to cancer and non-cancer inpatients during the lockdown and post-lockdown periods in Switzerland.
This study analyzed comprehensive adult acute care inpatient records from national administrative hospital data spanning 2017 to 2021. Using monthly patient-level data, comparative interrupted time series and difference-in-differences analysis were conducted to assess changes in hospital care between patients with and without an ICD-10 cancer diagnosis. Changes in admission volumes, hospital outcomes (length of stay, mortality), and cancer-specific treatments (chemotherapy, radiation therapy, and palliative care) during the lockdown and post-lockdown phases of the pandemic were analyzed.
Hospital admissions decreased substantially during the lockdown period. From March to May 2020, non-cancer patients experienced a reduction of 17'368 admissions (-18%) (95% CI [-24'333, -10'402]), compared with a reduction of 966 admissions (-9%) (95% CI [-1'636, -296]) for cancer patients. However, despite reduction in admissions, cancer inpatients received critical treatments at rates that were no lower for chemotherapy, and 6% (95% CI [1, 12]) and 15.2% (95% CI [10; 20]) higher for radiation therapy and palliative care, respectively, during the lockdown period compared to pre-pandemic levels. The mortality rate for both groups increased during the lockdown, but the rise was 22% (95% CI [8, 32]) smaller for cancer patients compared to non-cancer patients. The length of stay increased for both groups during the lockdown. However, the difference in length of stay between cancer and non-cancer patients vanished during the lockdown, with a higher length of stay of only 0.06 days (95% CI [-0.05, 0.18]) for cancer patients, compared to 0.40 days (95% CI [0.37, 0.43]) before the lockdown.
Swiss hospitals were able to maintain access to cancer services during the pandemic, mitigating the impact of the COVID-19 crisis for cancer population. These findings contribute to highlight the resilience of healthcare systems and understand decision-making processes during public health emergencies. However, long-term consequences of reduced care for cancer patients warrants further investigation.
新冠疫情给全球医疗系统带来了前所未有的压力，导致各国政府和医院推迟了择期手术，以便优先治疗新冠患者。癌症患者通常需要频繁与医院服务部门接触，可能受到了医疗服务中断的影响尤为严重。本研究旨在分析和比较瑞士在封锁期和封锁解除期为癌症住院患者和非癌症住院患者提供的医院护理情况。
本研究分析了2017年至2021年全国行政医院数据中的成人急性综合护理住院记录。利用每月患者层面的数据，进行了比较中断时间序列分析和差异分析，以评估有无国际疾病分类第十版（ICD-10）癌症诊断的患者在医院护理方面的变化。分析了疫情封锁期和封锁解除期住院人数、医院治疗结果（住院时间、死亡率）以及癌症特异性治疗（化疗、放疗和姑息治疗）的变化。
封锁期间医院入院人数大幅下降。2020年3月至5月，非癌症患者入院人数减少了17368人（-18%）（95%置信区间[-24333, -10402]），而癌症患者入院人数减少了966人（-9%）（95%置信区间[-1636, -296]）。然而，尽管入院人数减少，但癌症住院患者接受关键治疗的比例在化疗方面不低于疫情前水平，在放疗和姑息治疗方面，与疫情前水平相比，封锁期间分别高出6%（95%置信区间[1, 12]）和15.2%（95%置信区间[10, 20]）。封锁期间两组患者的死亡率均有所上升，但癌症患者的上升幅度比非癌症患者小22%（95%置信区间[8, 32]）。封锁期间两组患者的住院时间均增加。然而，癌症患者和非癌症患者住院时间的差异在封锁期间消失，癌症患者的住院时间仅比封锁前高0.06天（95%置信区间[-0.05, 0.18]），而非癌症患者为0.40天（95%置信区间[0.37, 0.43]）。
瑞士医院在疫情期间能够维持癌症服务的可及性，减轻了新冠危机对癌症患者群体的影响。这些发现有助于凸显医疗系统的韧性，并理解公共卫生紧急情况下的决策过程。然而，癌症患者护理减少的长期后果值得进一步研究。
