OA06.05 Impact of COVID-19 Pandemic on Proportion and Treatment Patterns for Stage I Non-small Cell Lung Cancer in the Netherlands

IntroductionCOVID-19 has profoundly changed healthcare practice worldwide. Due to scarcity of resources, overflowing health care facilities and fear of infection, treatment and referral patterns changed. This study aims to investigate the impact of the COVID-19 pandemic on treatment patterns for stage I Non-Small Cell Lung Cancer (NSCLC) in the Netherlands.MethodsAll patients treated for clinical stage I NSCLC from 2018 to 2020 that were registered in the Dutch Lung Cancer Audit in the Netherlands were included in this study. Primary outcome was defined as number of patients diagnosed with stage I NSCLC and their respective treatment (SBRT or surgery). In 2020 this was related to three periods based on COVID-19 hospital admission rates: ‘First wave’, ‘Interim period’ and ‘Second wave’. Data from stage I NSCLC patients from 2018 and 2019 were used as reference period. Secondary outcomes were defined as patient characteristics, hospital stay, ICU admission, postoperative complications and 30-day mortality for surgery patients. For patients treated with SBRT patient characteristics, acute toxicity and 90 day mortality were analyzed. Secondary outcomes were compared with 2018 and 2019.ResultsIn total, 7422 patients with cTNM stage I NSCLC were analyzed. During 2020, the annual number of stage I NSCLC diagnoses decreased by 21% compared to 2018-2019 (mean 2664 vs. 2094). Especially during the first COVID wave, the observed number of diagnoses was lower than expected. Subsequently, surgeries and SBRT treatments decreased sharply during the first wave. However, during the interim period and second wave, SBRT treatments recovered more than the number of surgeries. In 2020, a smaller portion of stage I NSCLC patients was treated with surgery compared to reference years (38% vs. 40%, p=0.04). More comorbidity (Charlson Comorbidity Index) was observed among surgical patients in 2020. Treatment delays did not increase during 2020. Median hospital and ICU stay were shorter in 2020 compared with 2018-2019 (4 vs. 5 days, p<0.05; 1 vs 2 days, p<0.05, respectively). Postoperative complications and 30-day mortality did not significantly differ. For SBRT patients in 2020, there were no significant differences in patient characteristics, toxicity and 90-day mortality compared with reference years.ConclusionsKeywordsCovid-19, Non Small Cell Lung Cancer, Treatment patterns IntroductionCOVID-19 has profoundly changed healthcare practice worldwide. Due to scarcity of resources, overflowing health care facilities and fear of infection, treatment and referral patterns changed. This study aims to investigate the impact of the COVID-19 pandemic on treatment patterns for stage I Non-Small Cell Lung Cancer (NSCLC) in the Netherlands.