1691O - Trends in new patient consultations during the COVID-19 pandemic at a comprehensive cancer centre in a public healthcare system

Background

The impact of COVID-19 pandemic-related disruptions on cancer services is still emerging. We describe trends in new patient consultations in a comprehensive cancer centre before and during the pandemic.

Methods

New patient consultations were reviewed in the Princess Margaret Cancer Registry and grouped by Year=Y and quarter=Q1-Q4. Periods of interest were: baseline (Y2018-2019), pandemic declaration (Y2020Q1-Y2020Q2) and post-declaration period (PDP) (Y2020Q2-Y2021Q1). Logistic regression models were used to assess the effect of period before and during the COVID-19 pandemic on stage at presentation and adjusted for age, sex and diagnosis location (our hospital network vs. elsewhere).

Results

53,759 new patient consultations took place from Jan 1, 2018-June 30, 2022. After pandemic declaration, new consultations decreased by 43.3% in Y2020Q2. During the PDP there were 2047 fewer overall, and 1618 new primary, consultations than expected which were not made up for at latest follow-up. The cancer sites with largest reduction in new primary assessments were neuroendocrine (84.6%), esophageal (62.1%) and colorectal (50.9%). Patients presenting with metastatic cancers were less likely to be diagnosed within our hospital network (aOR 0.70; CI 0.66-0.74, p<0.001), while patients with early-stage cancers were more likely (aOR 1.43; CI 1.34-1.52, p<0.001). After easing of pandemic restrictions in Y2020Q3, new patient assessments for metastatic cancers were higher than expected (aOR 1.23; CI 1.08-1.40, p=0.002). During the later periods of Y2021Q3-Y2022Q2 the odds of assessment for Stage 2/3 cancers were significantly lower than expected (aOR 0.81-0.90).

Conclusions

A large reduction in new patient consultations occurred during the COVID-19 pandemic; representing a gap in new cancer detection or change in care patterns with shift to other centres. The proportion of patients with stage 4 disease at consultation increased directly after the lockdown lifted, while the proportion of early-stage assessments remained below baseline during the later quarters, suggesting a protracted system recovery. Quantifying these changes are crucial for informing care delivery and recovery strategies.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

M.K. Krzyzanowska: Non-Financial Interests, Personal, Advisory Board: Bayer, Eisai, Ipsen, Lilly; Non- Financial Interests, Institutional, Funding: Eisai, Exelixis, Lilly. All other authors have declared no conflicts of interest.