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. 2020 Dec 21:19:eAO6282.
doi: 10.31744/einstein_journal/2021AO6282. eCollection 2020.

Impact of COVID-19 pandemic on care of oncological patients: experience of a cancer center in a Latin American pandemic epicenter

[Article in English, Portuguese]
Sérgio Eduardo Alonso Araujo  1 , Alessandro Leal  1 , Ana Fernanda Yamazaki Centrone  1 , Vanessa Damazio Teich  1 , Daniel Tavares Malheiro  1 , Adriana Serra Cypriano  1 , Miguel Cendoroglo Neto  1 , Sidney Klajner  1
Affiliations

Impact of COVID-19 pandemic on care of oncological patients: experience of a cancer center in a Latin American pandemic epicenter

[Article in English, Portuguese]
Sérgio Eduardo Alonso Araujo et al. Einstein (Sao Paulo). .

Abstract
in English, Portuguese

Objective: Since the rising of coronavirus disease 2019 (COVID-19) pandemic, there is uncertainty regarding the impact of transmission to cancer patients. Evidence on increased severity for patients undergoing antineoplastic treatment is posed against deferring oncologic treatment. We aimed to evaluate the impact of COVID-19 pandemic on patient volumes in a cancer center in an epicenter of the pandemic.

Methods: Outpatient and inpatient volumes were extracted from electronic health record database. Two intervals were compared: pre-COVID-19 (March to May 2019) and COVID-19 pandemic (March to May 2020) periods.

Results: The total number of medical appointments declined by 45% in the COVID-19 period, including a 56.2% decrease in new visits. There was a 27.5% reduction in the number of patients undergoing intravenous systemic treatment and a 57.4% decline in initiation of new treatments. Conversely, there was an increase by 309% in new patients undergoing oral chemotherapy regimens and a 5.9% rise in new patients submitted to radiation therapy in the COVID-19 period. There was a 51.2% decline in length of stay and a 60% reduction in the volume of surgical cases during COVID-19. In the stem cell transplant unit, we observed a reduction by 36.5% in length of stay and a 62.5% drop in stem cell transplants.

Conclusion: A significant decrease in the number of patients undergoing cancer treatment was observed after COVID-19 pandemic. Although this may be partially overcome by alternative therapeutic options, avoiding timely health care due to fear of getting COVID-19 infection might impact on clinical outcomes. Our findings may help support immediate actions to mitigate this hypothesis.

Objetivo: Desde o surgimento da pandemia da doença pelo coronavírus 2019 (COVID-19), há incerteza quanto ao impacto da transmissão para pacientes com câncer. As evidências sobre o aumento da gravidade para pacientes submetidos a tratamento antineoplásico são contra o adiamento do tratamento oncológico. Nosso objetivo foi avaliar o impacto da pandemia de COVID-19 em volumes de pacientes em um centro oncológico, em um epicentro da pandemia.

Métodos: Os volumes de pacientes ambulatoriais e de internação foram extraídos do banco de dados de prontuários eletrônicos. Dois intervalos foram comparados: períodos pré-COVID-19 (março a maio de 2019) e pandemia COVID-19 (março a maio de 2020).

Resultados: O número total de consultas médicas diminuiu 45% no período pandemia COVID-19, inclusive com redução de 56,2% nas novas consultas. Houve redução de 27,5% no número de pacientes em tratamento sistêmico intravenoso e de 57,4% no início de novos tratamentos. Por outro lado, ocorreram aumento de 309% em novos pacientes submetidos a regimes de quimioterapia oral e elevação de 5,9% em novos pacientes submetidos à radioterapia no período pandemia COVID-19. Observaram-se queda de 51,2% nos dias de internação e redução de 60% no volume de casos cirúrgicos durante a COVID-19. Na unidade de transplante de células-tronco, a redução foi de 36,5% nos dias de internação e de 62,5% nos transplantes de células-tronco.

Conclusão: Foi observado declínio significativo no número de pacientes em tratamento de câncer após a pandemia de COVID-19. Embora isso possa ser parcialmente superado por opções terapêuticas alternativas, evitar cuidados de saúde oportunos devido ao medo de contrair COVID-19 pode impactar nos resultados clínicos. Nossos resultados podem ajudar a apoiar ações imediatas para mitigar essa hipótese.

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Conflict of interest statement

Conflict of interest: none.

Figures

Figure 1
Figure 1. Timeline of measures in response to the COVID-19 pandemic in the city of São Paulo, Brazil, 2020
Figure 2
Figure 2. Percent changes in the volume of cancer healthcare services in 2020 compared to the equivalent 3-month period in 2019 (pre-COVID-19 pandemic)
Figura 1
Figura 1. Cronograma das medidas em resposta à pandemia da COVID-19 na cidade de São Paulo, Brasil, 2020
Figura 2
Figura 2. Mudanças percentuais no volume de serviços de saúde oncológicos em 2020 em comparação ao período trimestral equivalente em 2019 (pré-pandemia da COVID-19)
See this image and copyright information in PMC

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