Abstract 1228P
Background
COVID-19 has significantly disrupted cancer care. This may have impacted on staging, management and survival as health services worldwide had to adapt. Responding to the pandemic, the United Kingdom (UK) government declared a national lockdown on 23rd March 2020. This national study investigated the effect of the national response on oesophago-gastric (OG) cancers in Scotland, including time from referral to gastroscopy, staging at presentation, multidisciplinary team (MDT) treatment outcomes and overall survival.
Methods
This was a retrospective cohort study. Consecutive new patients presenting in NHS Scotland to five regional OG cancer MDTs covering 93.2% of the Scottish population between October 2019 and September 2020 were identified. Electronic health records were reviewed. The study period was divided into pre- and post-lockdown, based on the first UK national lockdown.
Results
931 patients with biopsy-proven OG cancer were identified; 499 (53.6%) pre- and 432 (46.4%) post-lockdown. Median age was 71 years (range 25-95) and 66% were male. There were 252 (27.1%) gastric and 679 (72.9%) oesophageal cancers. No clinically meaningful difference in median time to gastroscopy was observed post-lockdown (19 days vs 15 days, p<0.001), however, patients were more likely to present as an emergency (11.1% vs 8.2%, p=0.014). Post-lockdown, patients tended to poorer ECOG PS (p=0.09), were more symptomatic (p=0.007), and presented with higher stage disease (stage 4; 57.6% vs 49.3%). There was a significant shift to palliative intent treatment post-lockdown (76.2% vs 64.7%, p<0.001). Median overall survival post-lockdown was 7.6 months vs 10.1 months pre-lockdown (HR 1.24; 95% CI 1.06-1.43, p=0.005).
Conclusions
This national study highlights the impact of COVID-19 on OG cancer diagnosis and outcome in Scotland. Patients presented at a later stage and a shift towards palliative intent treatment was observed, with subsequent negative impact on overall survival. The reason for the observed stage migration of OG cancers is likely multifactorial, occurring prior to the diagnostic pathway and not simply due to a delay in performing gastroscopy.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
M. Baxter: Financial Interests, Personal, Invited Speaker: Ipsen, Bristol-Myers Squib; Financial Interests, Personal, Advisory Role: Servier; Financial Interests, Personal, Other, Travel: Ipsen. R. Petty: Financial Interests, Personal, Advisory Board: BMS, Servier, Lilly, Sanofi; Financial Interests, Personal, Invited Speaker: BMS, Servier, Pfizer, BMS; Financial Interests, Personal, Other, Funding to attend Congress: BMS; Financial Interests, Personal, Other, Funding to attend congress: Lilly; Financial Interests, Institutional, Invited Speaker: AstraZeneca, Boston Biomedical, MSD, Clovis, Five Prime Therapeutics, Lilly, Merck Serono, Janssen, Roche, Amgen, Astellas; Financial Interests, Institutional, Research Grant: AstraZeneca; Non-Financial Interests, Institutional, Product Samples: Lilly. All other authors have declared no conflicts of interest.