155 Treatment of oropharyngeal cancer during lockdown - outcomes for patients treated during the pandemic

• Published in: Radiotherapy and oncology Vol. 192; pp. S182 - S184
• Main Authors: O'Dwyer, Niall, O'Connell, Liam, Browne, Darragh, Dunne, Mary, Brennan, Sinead, Duane, Frances, Armstrong, John, Boychak, Alex, McArdle, Orla
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 01-03-2024
• Subjects: COVID-19; Oropharynx; survival; COVID-19; HPV or EBV related cancers; Oropharynx; survival
• ISSN: 0167-8140; 1879-0887
• DOI: 10.1016/S0167-8140(24)00516-4

The onset of the COVID-19 outbreak caused major interruptions to the entire healthcare network affecting most oncological referral, diagnosis and treatment pathways. Oropharyngeal cancer patients were a particularly vulnerable group during this period as many were reluctant to present to hospital due to their concerns of contracting the virus. This created a potential for delayed presentation in keeping with more advanced disease with potential for worsened outcomes.
We designed a retrospective study to analyse differences in patient presenting stage, treatment encountered, delays encountered and treatment outcomes for patients with oropharyngeal cancer treated before and during the COVID pandemic.
All patients receiving radical radiotherapy for oropharyngeal cancer pre-COVID (July 17–July 18= GROUP 1) and during COVID (Mar 20–Mar 21= GROUP 2) in a large Irish tertiary referral network were included. Patient and disease characteristics, diagnostic timelines, treatment delays and disease outcomes were extracted from patient records. Patients were excluded if performance status was not suitable for curative treatment, if evidence of metastatic disease or if any history of prior head and neck radiotherapy.
[Display omitted] 159 patients were suitable for assessment, 76 in Group 1 and 83 in Group 2. Median follow up was 48 months in Group 1 and 23 months in Group 2. When comparing Group 1 and 2: TNM overall stage were as follows: Stage 1: (25% vs 45.8%), Stage 2: (28.9% vs 18%), Stage 3:(21% vs 15.7%), Stage 4:(25% vs 20.5%). When grouped by stage we found no statistically significant difference in presentation stage between Group 1 and 2 (p=0.268).
Use of hypofractionated regimen (65Gy/30fr) increased during the pandemic (2.6% to 10.8%) in keeping with international guidelines. There was no change in numbers of patients experiencing significant treatment delays between groups, with COVID related sepsis accounting for one significant delay and one death during treatment.
There was a small but non-significant reduction in the use of concomitant chemotherapy from 93.4% in group 1 to 85.5% in group 2 (p=0.269).
Overall survival assessed at 2 years was 77% in Group 1 and 85% in Group 2 (p=0.350). Disease free survival assessed at 2 years was 69% in Group 1 and 76% in Group 2 (p=0.567). [Display omitted]
In spite of challenges related to the COVID-19 pandemic, this study has demonstrated that oropharyngeal cancer patients’ treatment standards and outcomes were maintained within a large tertiary referral centre in Ireland. This study is one of the largest assessing the impact of the COVID-19 pandemic on head and neck radiotherapy patients. We did not demonstrate any difference in overall survival and disease free survival at 2 years when compared to a similar group prior to the pandemic. Furthermore we did not demonstrate any worsening of presenting stage related to delayed presentations during the pandemic.