Impact of the COVID-19 pandemic on disease stage and treatment for patients with pancreatic adenocarcinoma: A French comprehensive multicentre ambispective observational cohort study (CAPANCOVID)

The COVID-19 pandemic caused major oncology care pathway disruption. The CAPANCOVID study aimed to evaluate the impact on pancreatic adenocarcinoma (PA) – from diagnosis to treatment – of the reorganisation of the health care system during the first lockdown. This multicentre ambispective observatio...

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Published in:	European journal of cancer (1990) Vol. 166; pp. 8 - 20
Main Authors:	Brugel, Mathias, Letrillart, Léa, Evrard, Camille, Thierry, Aurore, Tougeron, David, El Amrani, Mehdi, Piessen, Guillaume, Truant, Stéphanie, Turpin, Anthony, d'Engremont, Christelle, Roth, Gaël, Hautefeuille, Vincent, Regimbeau, Jean M., Williet, Nicolas, Schwarz, Lilian, Di Fiore, Frédéric, Borg, Christophe, Doussot, Alexandre, Lambert, Aurélien, Moulin, Valérie, Trelohan, Hélène, Bolliet, Marion, Topolscki, Amalia, Ayav, Ahmet, Lopez, Anthony, Botsen, Damien, Piardi, Tulio, Carlier, Claire, Bouché, Olivier
Format:	Journal Article
Language:	English
Published:	England Elsevier Ltd 01-05-2022 Elsevier Science Ltd Elsevier
Subjects:	Adenocarcinoma Adenocarcinoma - epidemiology Adenocarcinoma - therapy Cancer Care pathway Chemotherapy Cohort analysis Cohort Studies Communicable Disease Control Coronaviruses COVID-19 COVID-19 - epidemiology Diagnosis Diseases Health care Health services Human health and pathology Humans Life Sciences Metastases Observational studies Original Research Pancreas Pancreatic cancer Pancreatic Neoplasms Pancreatic Neoplasms - epidemiology Pancreatic Neoplasms - pathology Pancreatic Neoplasms - therapy Pandemic Pandemics Patients SARS-CoV-2 Severe acute respiratory syndrome coronavirus 2 Tumors Viral diseases COVID-19 Care pathway Pandemic SARS-CoV-2 Pancreatic neoplasms Cancer
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Summary:	The COVID-19 pandemic caused major oncology care pathway disruption. The CAPANCOVID study aimed to evaluate the impact on pancreatic adenocarcinoma (PA) – from diagnosis to treatment – of the reorganisation of the health care system during the first lockdown. This multicentre ambispective observational study included 833 patients diagnosed with PA between September 1, 2019 and October 31, 2020 from 13 French centres. Data were compared over three periods defined as before the outbreak of COVID-19, during the first lockdown (March 1 to May 11, 2020) and after lockdown. During the lockdown, mean weekly number of new cases decreased compared with that of pre-pandemic levels (13.2 vs. 10.8, −18.2%; p = 0.63) without rebound in the post-lockdown period (13.2 vs. 12.9, −1.7%; p = 0.97). The number of borderline tumours increased (13.6%–21.7%), whereas the rate of metastatic diseases rate dropped (47.1%–40.3%) (p = 0.046). Time-to-diagnosis and -treatment were not different over periods. Waiting neoadjuvant chemotherapy in resectable tumours was significantly favoured (24.7%–32.6%) compared with upfront surgery (13%–7.8%) (p = 0.013). The use of mFOLFIRINOX preoperative chemotherapy regimen decreased (84.9%–69%; p = 0.044). After lockdown, the number of borderline tumours decreased (21.7%–9.6%) and advanced diseases increased (59.7%–69.8%) (p = 0.046). SARS-CoV-2 infected 39 patients (4.7%) causing 5 deaths (12.8%). This cohort study suggests the existence of missing diagnoses and of a shift in disease stage at diagnosis from resectable to advanced diseases with related therapeutic modifications whose prognostic consequences will be known after the planned follow-up. Clinicaltrials.gov NCT04406571. •A total of 833 patients with pancreatic adenocarcinoma were analysed.•During the lockdown, the weekly number of new cases decreased by 18.2%.•Neoadjuvant chemotherapy was favoured compared with upfront surgery (p = 0.013).•Disease stage shifted from localised to advanced disease (p = 0.046).•SARS-CoV-2 infected 39 patients (4.7%) causing 5 deaths (12.8%).
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3 PMCID: PMC8828421 Equally contributing first authors.
ISSN:	0959-8049 1879-0852
DOI:	10.1016/j.ejca.2022.01.040