The Impact of COVID-19 Pandemic among Cancer Patients

PURPOSE/OBJECTIVE(S): Clinical visits play an important role in disease management among cancer patients. The Covid-19 pandemic has hindered patients from seeking care and has changed treatment recommendations. We evaluated how the Covid-19 pandemic affected patients’ health outcomes, related to the changing choice of treatment, and the association with demographic variables. MATERIALS/METHODS: 17,062 cancer patients who received routine care at our institution between January 1, 2019 and March 31, 2021 were studied. As the Covid-19 outbreak was declared to be a public health emergency within the United States on January 31, 2020, a binary Covid variable is defined as pre- or post-Covid based on whether the cancer was diagnosed prior to/on this date or after this date and treatment variable as radiation, other or no therapy being given. Age within the pre- and post-Covid cohorts was compared via two-sample t-test and the association between gender, partnership status, treatment, and Covid was assessed via chi-squared tests. The relationship between time from the date of diagnosis to death (the primary outcome), and Covid, adjusted for covariates (age, gender, partnership status, and treatment) was evaluated via the Cox proportional hazards (Cox PH) model. The impact of Covid on the treatment effect to overall survival was further assessed by including interactions between Covid and treatment. RESULTS: Among 17,062 cancer patients, 11,477 (67.3%) and 5,585 (32.7%) were diagnosed within pre- and post-Covid cohorts. Age was found to be different between the pre- and post-Covid (mean±SD: 64.6±15.1 vs 63.7±15.7; p<0.001). Gender, partnership status, and treatment were also found to be associated with Covid (all p<0.002); while a lower percentage of patients received radiation therapy within the post-Covid (26.6%) than the pre-Covid (34.7%), a greater percentage received other therapy within the post-Covid (60.7%) than the pre-Covid (51.7%). Both Covid cohorts included more females (51.3% pre vs 53.8% post) and partnered patients (62.3% pre vs 61.5% post). All covariates, including the interaction term, in the Cox PH model were significant predictors of overall survival, with older, non-partnered, male, post-Covid, and no therapy patient having a greater hazard to death (all p<0.007). Patients within the post-Covid had a greater hazard to death regardless of the given treatment, compared to the pre-Covid (Hazard Ratio: 1.18, 1.09, 2.35 for radiation, other and no therapy). CONCLUSION: Covid-19 impacts patient care in multiple aspects. This impact is associated with age, gender and partnership status. Treatment choices also differed between patients who had a cancer diagnosis within pre- vs post-Covid cohorts. With different impact of Covid-19 on the treatment effect to overall survival, patients within the post-Covid had a greater hazard to death regardless of the given treatment. Further study is needed to better understand these observations.