The impact of the COVID-19 pandemic on head and neck cancer diagnosis in the Piedmont Region, Italy: interrupted time-series analysis

Popovic, M. et al. (2022) The impact of the COVID-19 pandemic on head and neck cancer diagnosis in the Piedmont Region, Italy: interrupted time-series analysis. Frontiers in Public Health, 10, 809283. (doi: 10.3389/fpubh.2022.809283) (PMID:35265573) (PMCID:PMC8899030)

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Background: The COVID-19 pandemic has likely affected the most vulnerable groups of patients and those requiring time-critical access to healthcare services, such as patients with cancer. The aim of this study was to use time trend data to assess the impact of COVID-19 on timely diagnosis and treatment of head and neck cancer (HNC) in the Italian Piedmont region. Methods: This study was based on two different data sources. First, regional hospital discharge register data were used to identify incident HNC in patients ≥18 years old during the period from January 1, 2015, to December 31, 2020. Interrupted time-series analysis was used to model the long-time trends in monthly incident HNC before COVID-19 while accounting for holiday-related seasonal fluctuations in the HNC admissions. Second, in a population of incident HNC patients eligible for recruitment in an ongoing clinical cohort study (HEADSpAcE) that started before the COVID-19 pandemic, we compared the distribution of early-stage and late-stage diagnoses between the pre-COVID-19 and the COVID-19 period. Results: There were 4,811 incident HNC admissions in the 5-year period before the COVID-19 outbreak and 832 admissions in 2020, of which 689 occurred after the COVID-19 outbreak in Italy. An initial reduction of 28% in admissions during the first wave of the COVID-19 pandemic (RR 0.72, 95% CI 0.62–0.84) was largely addressed by the end of 2020 (RR 0.96, 95% CI 0.89–1.03) when considering the whole population, although there were some heterogeneities. The gap between observed and expected admissions was particularly evident and had not completely recovered by the end of the year in older (≥75 years) patients (RR: 0.88, 0.76–1.01), patients with a Romano-Charlson comorbidity index below 2 (RR 0.91, 95% CI: 0.84–1.00), and primary surgically treated patients (RR 0.88, 95% CI 0.80–0.97). In the subgroup of patients eligible for the ongoing active recruitment, we observed no evidence of a shift toward a more advanced stage at diagnosis in the periods following the first pandemic wave. Conclusions: The COVID-19 pandemic has affected differentially the management of certain groups of incident HNC patients, with more pronounced impact on older patients, those treated primarily surgically, and those with less comorbidities. The missed and delayed diagnoses may translate into worser oncological outcomes in these patients.

Item Type:Articles
Keywords:Public health, COVID-19, head and neck, cancer detection, Italy, interrupted time-series analysis (ITSA), time trend analyses, head and neck cancers, cancer.
Glasgow Author(s) Enlighten ID:Conway, Professor David
Authors: Popovic, M., Fiano, V., Moirano, G., Chiusa, L., Conway, D. I., Garzino Demo, P., Gilardetti, M., Iorio, G. C., Moccia, C., Ostellino, O., Pecorari, G., Ramieri, G., Ricardi, U., Riva, G., Virani, S., and Richiardi, L.
College/School:College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Dental School
Journal Name:Frontiers in Public Health
Publisher:Frontiers Media
ISSN (Online):2296-2565
Copyright Holders:Copyright © 2022 Popovic, Fiano, Moirano, Chiusa, Conway, Garzino Demo, Gilardetti, Iorio, Moccia, Ostellino, Pecorari, Ramieri, Ricardi, Riva, Virani and Richiardi
First Published:First published in Frontiers in Public Health 10: 809283
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
303648HEADSPACEDavid ConwayEuropean Commission (EC)825771Med - Dental School