Delay in Diagnosis and Treatment of Primary Bone Tumors during COVID-19 Pandemic in Poland

SIMPLE SUMMARY: The diagnosis and treatment of patients with bone neoplasms is often a demanding task, and at the same time, inadequate treatment may worsen the patients’ prognosis. During the COVID-19 pandemic, the change of priorities caused a limitation or even a temporal pause of elective healthcare in medical facilities, which included: delays in or rescheduling of outpatient visits, planned diagnostic and therapeutic procedures, as well as a shift towards telemedicine, which precluded the proper physical examination of the patients. Therefore, the aim of our study was to determine how the pandemic influenced the diagnostic and therapeutic processes for patients with primary bone tumors, and what lessons we can learn for the future. In addition, our goal was to verify whether surgical treatment during the COVID-19 pandemic could be safe for patients with bone tumors. In our study, we did not observe an extension of the delay in diagnosis during the COVID-19 pandemic, however, those patients reported to oncology centers with larger tumors compared to those of the patients who were treated before the pandemic. The COVID-19 pandemic had a negative impact on the delay in performing biopsies, however, it did not significantly affect the therapeutic process itself. At the same time, we indicated that the patients with bone tumors can be successfully treated surgically without experiencing an unnecessary delay, if all the precautions are taken. ABSTRACT: Background: The COVID-19 pandemic has affected all of the medical specialties, including orthopedic oncology. Therefore, the aim of the study was to assess how it influenced the diagnostic and therapeutic processes for patients with bone neoplasms. Methods: We evaluated 87 patients treated due for bone neoplasms before (Group I, n = 36) and during the COVID-19 pandemic (Group II, n = 51). A delay in diagnosis was defined as the period between the initial clinical symptoms and the date of referral to an oncology center. The patients from Group II were asked to complete a short questionnaire regarding the COVID-19 pandemic. Results: The median general delay in diagnosis before the pandemic was 7 months, while during the pandemic, it was 10 months (p = 0.728). The biopsy delay was lower in the pre-pandemic group: median-6.5 vs. 12 days (p = 0.025). The patients from Group II were diagnosed with larger tumors compared to those in Group I: the median values were 75 vs. 56 mm (p = 0.025), respectively. After an X-ray examination, the bone neoplasms were suspected more frequently in the Group II: 63% vs. 44% cases (p = 0.024), respectively. In Group II, 20 (60.8%) cases of SARS-CoV-2 infection were reported, however, no respiratory failure cases were noticed. Conclusion: The pandemic affected the diagnostic process of primary bone tumors, resulting in delays in performing biopsies. During the pandemic, the patients reported larger diameters of their bone lesions.