Impact of the COVID-19 pandemic on disease progression in patients with hepatobiliary and pancreatic cancer.
Authors: Reategui-Almonacid Yazmin , Patel Raag , Satuluru Siddharth , Pavkov Isabela , Abure Queen , Sturdevant Mikenzie , Chibane Fairouz , Colquhoun Steven , Nayak Asha , Yakoub Danny 
Published: July 2024

e16246

Background: The COVID-19 pandemic has posed challenges to healthcare systems, notably impacting cancer care. For patients with Hepatobiliary and Pancreatic Cancer, there has been a reported decline in median survival. The etiology of this decline, whether it is attributed to an escalation in disease severity or to delays in diagnosis and treatment remains unclear. Methods: This retrospective study analyzed the National Cancer Database (NCDB 2004-2020) data from 2018 to 2020. We compared time from diagnosis to initial treatment, AJCC (2017) TNM clinical stage distribution, and pathological variables suggestive of tumor aggression between the pre-pandemic and pandemic periods, as well as within COVID-19 positive (C19+) and negative (C19-) patients. Results: The study included 17,429 liver cancer (LC), 37,185 pancreatic cancer (PC), 1,684 gallbladder cancer (GC), and 3,651 intrahepatic biliary cancer (IBC) patient’s pre-pandemic, and 14,420 LC and 35,456 PC, 1,457 GC, and 3,792 IBC patients during the pandemic. The time to initial treatment did not significantly differ in the before and during the pandemic groups for all types of cancer. However, for GC, there was a significant increase in days to definitive surgery during the pandemic 54 ±73 days compared to pre-pandemic 28±53 days (p < 0.01). There was also a notable increase in the time to initial treatment and definitive surgery for pancreatic cancer in C19+ patients (46±51, 118±104 days) compared to C19- patients (35±37, 97±89 respectively) (p < 0.01). For LC and GC, there was a significant increase in late-stage diagnoses during the pandemic period. LC (stage III: 23.67% and stage IV: 21.10%) compared to pre-pandemic (stage III: 22.71% and stage IV: 19.02%, p < 0.01). GC (stage IV: 77.0%) compared to pre-pandemic (stage IV: 71.85%, p < 0.01). Lympho-vascular invasion rates and node positivity ratios in HC, GC, and IBC patients remained unchanged. For PC there was no change in late stage distribution and IBC there were no significant differences in overall stage distribution or lympho-vascular invasion rates. However, a significant increase in node positive/node harvested ratio was observed in stage III C19+ PC patients (0.308±0.322) compared to C19- (0.134±0.181, p < 0.01). Conclusions: Cancer screening delays during the pandemic led to an increase in late-stage diagnoses for LC and GC but stage distributions for PC and IBC were largely unchanged. However, the pandemic's impact was subtly observed in the form of increased node positivity in stage III C19+ pancreatic cancer patients possibly due to their delay in initial treatment and surgery. There was also an increase in time to definitive surgery in gallbladder cancer. These findings underscore the importance of maintaining robust cancer care pathways, particularly for high-risk groups, to prevent adverse stage migration and ensure timely management, even in the face of global health emergencies.