Dramatic Changes in Oncology Care Pathways During the COVID-19 Pandemic: The French ONCOCARE-COV Study

Abstract

The coronavirus disease 2019 (COVID-19) pandemic may have affected cancer management. We aimed to evaluate changes in every oncology care pathway essential step, from screening to treatment, during the pandemic. Monthly oncological activity differences between 2019 and 2020 (screening tests, histopathological analyzes, multidisciplinary tumor board meetings (MTBMs), diagnostic announcement procedures (DAPs), and treatments were calculated in two French areas experiencing different pandemic intensity (Reims and Colmar). COVID-19 has had a dramatic impact in terms of screening (-86% to -100%), diagnosis (-39%), and surgical treatment (-30%). This global decrease in all essential oncology care pathway steps contrasted with the relative stability of chemotherapy (-9%) and radiotherapy use (-16%). Outbreak occurred earlier and with more intensity in Colmar but had a comparable impact in both areas regarding MTMBs and DAPs. The current ONCOCARE-COV study is still in progress and with a longer follow-up to analyze postlockdown situation.

Figure 1

Monthly oncological activity volume difference between 2019 and 2020. Monthly changes in volume of oncological activities (%) are calculated with (2020 activity – 2019 activity) / 2019 activity and are illustrated through color variation from green (rising activity) to red (decreasing activity). Grey areas show unavailable data for the first analyses of the study. Further data collection is still in progress. (a) Reims University Hospital and Cancer Institute (Grand East region in France). (b) Colmar General Hospital (Grand East region in France). (c) Diagnosis announcement procedure (3 steps) is a measure of the first French cancer plan (2003‐2007). (d) Overall inpatients peak in Reims (April 5, 2020). (e) Overall inpatients peak in Colmar (March 24, 2020) Abbreviations: FIT, fecal immunochemical test; PET/CT, Positron emission tomography with computed tomography.

Figure 2

Temporal curves of monthly oncological activity volume (between January 2019 and May 2020) and of daily COVID‐19 pandemic indicators (between March 16, and June 15, 2020). (A): Screening activity in the Marne county. (B): Carcinologic histopathological analyses depending on tumor samples. (C); Biomolecular analyses (somatic and germline). (D): Multidisciplinary board meeting activity (comparison between Reims and Colmar centers). (E): Diagnostic announcement procedures (h). (F): Oncogeriatric evaluations. (G): Oncological surgical activity. (H): Cytotoxic chemotherapy activity. (I): Radiotherapy activity. (J): Daily COVID‐19 inpatients. (K): Daily cumulated deaths from COVID‐19. (a) The black dashed vertical line marks timeline of the first diagnosed COVID‐19 patient in France (January 24, 2020). (b) The orange dashed vertical line marks timeline of the first COVID‐19 deceased patient in France (February 15, 2020). (c) The red dashed vertical line marks timeline of the first COVID‐19 admitted patient in Reims (February 27, 2020). (d) The gray rectangular area marks the lockdown period (from March 17, 2020, to May 11, 2020). (e) The gray rectangular area marks a period of FIT stock shortage (from April 15, 2019, to July 25, 2019). (f) University Hospital and Godinot Cancer Institute, Reims, France. (g) Pasteur General Hospital, Colmar, France. (h) Diagnosis announcement procedure (3 steps) is a measure of the first French cancer plan (2003–2007). (i) The black dashed vertical line marks timeline of the overall inpatients peak (226 inpatients) in Colmar (March 24, 2020). (j) The black dashed vertical line marks timeline of the overall inpatients peak (158 inpatients) in Reims (April 5, 2020). Abbreviations: COVID‐19, coronavirus disease 2019; CT, computed tomography; FIT, fecal immunochemical test.