Effects of the COVID-19 pandemic on staging and treatment patterns in non-small cell lung cancer: A large national study.

Abstract

e23332 Background: The COVID-19 (C19) pandemic significantly impacted oncology care access, treatment delivery, and provider practice patterns. It was estimated that lack of screening during the pandemic would lead to an increase in late-stage lung cancer diagnosis. Hence, we investigated a large national database to study C19’s impact on staging and treatment for non-small cell lung cancer (NSCLC) in the United States. Methods: Data from the National Cancer Database (NCDB) on all NSCLC cases diagnosed between 2019 and 2021 were analyzed. The cases were stratified into three time periods: 2019 (pre-C19), 2020 (early C19), and 2021 (late C19). The stratified groups were adjusted for demographics, socioeconomic status, insurance type, comorbidities, treatment modalities, and stage at diagnosis according to the 8th edition of the AJCC staging system. Results: The majority of the 263,974 included patients were 60-79y (68.5%), female (50.5%), white (83.0%), non-Hispanic (96.3%), and Medicare-insured (66.3%), with upper lobe as primary tumor site (52.9%). Minimal staging difference was observed overall across the periods, with stage proportions within each year all ±1.2% from their respective total. However, noticeable changes were observed between early and late C19, with a 1.8% increase in stage I diagnoses and a 1.9% decrease in stage IV diagnoses, respectively. Small changes existed in treatment modality distribution across the periods, with treatment cohorts within each year all ±0.8% from their respective total. Chemotherapy (40.0% vs. 39.3%), radiotherapy (44.4% vs. 43.7%), and surgery (27.8% vs 27.1%) trended towards fewer uses pre-C19 vs. late C19, while immunotherapy (25.3% vs. 26.6%) and palliative care (12.1% vs. 13.0%) grew more common. Conclusions: Small but significant pandemic-era changes were observed in NSCLC care, including increased early-stage diagnoses, and use of immunotherapy and palliative care. Period-stratified staging and treatment modality breakdown. Stage at Diagnosis or Treatment Modality Received 2019 (n, %) 2020 (n, %) 2021 (n, %) Total (n, %) p-value I 33001 (34.8) 28403 (34.1) 30900 (35.9) 92304 (35.0) <0.001 II 7817 (8.3) 6516 (7.8) 6798 (7.9) 21131 (8.0) III 16819 (17.8) 14351 (17.2) 14878 (17.3) 46068 (17.4) IV 37062 (39.1) 33981 (40.8) 33448 (38.9) 104491 (39.6) Chemotherapy 37838 (40.0) 32928 (39.6) 33813 (39.3) 104579 (39.6) 0.017 Immunotherapy 23969 (25.3) 21954 (26.4) 22850 (26.6) 68773 (26.1) <0.001 Radiotherapy 42062 (44.4) 36553 (43.9) 37582 (43.7) 116197 (44.0) 0.006 Surgery 26334 (27.8) 22074 (26.5) 23321 (27.1) 71729 (27.2) <0.001 Palliative Care 11419 (12.1) 11261 (13.5) 11209 (13.0) 33889 (12.8) <0.001