Impact of the pandemic on surgical oncology in Piedmont, Italy: a retrospective observational study

Abstract Background To prevent the spread of SARS-CoV-2, containment measures were implemented leading to huge healthcare changes worldwide. This study aimed to describe the impact of COVID-19 pandemic on surgical oncology healthcare in a large Italian sample. Methods A retrospective observational study included 99651 patients admitted to the hospitals of Piedmont (Northern Italy) to undergo oncological surgery, provided in ordinary hospitalization. We compared data of 2020 with 2016-2019 mean values. Data were stratified by tumor site, year, month and admission way. Chi-squared tests were used to assess differences in the percentage of admission modes between 2020 and 2016-2019. Results An overall reduction in oncological surgery (-12.3%) was observed in 2020 (n = 17923) compared to the mean of period 2016-2019 (n = 20432). A relevant decrease began in March (-11%), continued in April (-18%) and peaked in May (-26%). There was a greater reduction in surgery of breast (-19.2%), bladder (-17.5%), colorectal (-16.5%), kidney (-14.2%), prostate (-14%). Little or no difference was observed for liver (-5.2%), body of uterus (-0.54%), ovary (-0.07%), lymphoma (+4.5%). There was a marked reduction of non-emergency admissions (-13.6%), in particular for some tumor sites: colorectal (-19.4%), breast (-19.4%), bladder (-18.7%). The overall volume of surgeries following an emergency access was unchanged (-0.3%). The proportion of hospitalizations with emergency access increased (p < 0.001). Conclusions Our results highlight the burden of the reduction in cancer surgery in 2020 and the risk of delays in diagnosis and treatment for time-dependent conditions. For cancers that can be diagnosed early thanks to screening, the reduction in surgery is likely to be an indirect consequence of discontinuing screening activities. Therefore, further studies are needed to assess, as soon as data are available, the trend in 2021, and to compare our results with those reported in other European countries. Key messages • The COVID-19 pandemic caused a significant decline in cancer surgeries in 2020 in Piedmont, Italy. It is necessary to compare our results with those reported in other European countries. • These results show an increase in the proportion of oncological surgical admissions following emergency access in 2020 compared to the average for 2016-2019.


Background:
To prevent the spread of SARS-CoV-2, containment measures were implemented leading to huge healthcare changes worldwide.This study aimed to describe the impact of COVID-19 pandemic on surgical oncology healthcare in a large Italian sample.

Methods:
A retrospective observational study included 99651 patients admitted to the hospitals of Piedmont (Northern Italy) to undergo oncological surgery, provided in ordinary hospitalization.We compared data of 2020 with 2016-2019 mean values.Data were stratified by tumor site, year, month and admission way.Chi-squared tests were used to assess differences in the percentage of admission modes between 2020 and 2016-2019.

Conclusions:
Our results highlight the burden of the reduction in cancer surgery in 2020 and the risk of delays in diagnosis and treatment for time-dependent conditions.For cancers that can be diagnosed early thanks to screening, the reduction in surgery is likely to be an indirect consequence of discontinuing screening activities.Therefore, further studies are needed to assess, as soon as data are available, the trend in 2021, and to compare our results with those reported in other European countries.

Key messages:
The COVID-19 pandemic caused a significant decline in cancer surgeries in 2020 in Piedmont, Italy.It is necessary to compare our results with those reported in other European countries.
Early evidence suggests that the COVID-19 pandemic may have reduced the proportion of individuals submitted to cervical, colorectal and breast cancer screening.However, the recovery from the pandemic impact was very heterogeneous.We aim to explore the impact of the pandemic on cancer screening and estimate the time to recover lost screening opportunities in Portugal.We used an interrupted time series to analyze the impact of the pandemic on the implementation of cancer screening.The study population was the eligible individuals screened for cervical, colorectal and breast cancer by month and health region between 2018 and 2021.We used Poisson regression with health region random effects to estimate the trend before and after the first lockdown (March 2020) and the impact of the first lockdown.We predicted the counterfactual evolution without a pandemic to estimate lost screening opportunities.The first lockdown resulted in 93,1% (95%CI 92,9-93,2), 89,4% (95%CI 89,2-89,5) and 84,1% (95%CI 83,8-84,3) decrease in the proportion of expected cervical, colorectal and breast cancer screening tests.Nonetheless, we document an increased trend difference between pre and post lockdown of 6,0% (95%CI 5,9-6,0) and 5,3% (95%CI 5,3-5,4), 3,7% (95%CI 3,6-3,7) per month.However, by December 2021, there are still many lost screening opportunities due to the pandemic -293k cervical cytology tests (42,2% less than expected), 247k fecal occult blood tests (28,7%) and 388k mammograms (38,4%).The first lockdown resulted in an abrupt decrease in cancer screening.However, we document an increase in the cancer screening trend after the pandemic.Nevertheless, there are still considerable lost screening opportunities after 2 years.

Key messages:
The pandemic caused a massive disruption in cancer screening.Although there was an increase in screening trends after the first lockdown, 2 years later, many lost screening opportunities remain.
Population-based screenings need to increase the outputs to account for lost screening opportunities due to the pandemic.