Impact of the first era of the coronavirus disease 2019 pandemic on gastric cancer patients: a single-institutional analysis in Japan

Abstract

Background: Little is known about the disadvantages of the coronavirus disease 2019 (COVID-19) pandemic in patients with gastric cancer. This study aimed to examine the negative impact of the COVID-19 pandemic on patients with gastric cancer in the first era in Japan.

Methods: This retrospective study included 725 patients diagnosed with gastric cancer who visited our hospital between April 2019 and March 2021. The number of patients and their characteristics before and during the COVID-19 pandemic were compared.

Results: The number of patients diagnosed with gastric cancer during the COVID-19 pandemic decreased by 26.2% (from 417 to 308; p = 0.013) compared to that before the COVID-19 pandemic. There was a significant decrease in cStage I cancer and an increase in cStage III cancer (p = 0.004). Patients were often symptomatic (p = 0.029), especially those with stenosis-related symptoms (p < 0.001) and longer symptom duration (p < 0.001). The number of endoscopic resections was decreased by 34.8% (p = 0.005). The number of total gastrectomy was higher than that of partial gastrectomy (p = 0.021). The median time to treatment was significantly shorter (p < 0.001).

Conclusions: In Japan, delays diagnosing patients with gastric cancer, probably due to refraining from consultation, may have resulted in an increase in the diagnosis of advanced-stage cancer. Moreover, an increasing proportion of patients required more invasive gastrectomy. Therefore, it may be necessary to educate patients not to refrain from consultation, even during the COVID-19 pandemic, as it can have a negative impact on treatment, policy decision, and prognosis of gastric cancer.

Keywords: COVID-19; Coronavirus; Gastric cancer.

Fig. 1

Number of patients with gastric cancer diagnosed in our institution per year over 6 recent years. The number of patients with gastric cancer did not decrease in 5 years before the COVID-19 pandemic

Fig. 2

a Comparison of the number of patients with gastric cancer per month before and during the COVID-19 pandemic. The total number of patients diagnosed with gastric cancer during the COVID-19 pandemic was decreased by 26.2% (from 417 to 308), compared to the number before the COVID-19 pandemic. b Number of COVID-19 patients per 100,000 population in Japan and in Saitama prefecture

Fig. 3

Comparison of the mean number of patients with gastric cancer per month diagnosed before and during the COVID-19 pandemic according to each period. Throughout the year, the number of patients diagnosed during the COVID-19 pandemic was decreased, compared to that before the COVID-19 pandemic (34.8 ± 2.2 vs. 25.7 ± 2.2, p = 0.013). Similarly, the number of patients was decreased during the first half of the period during compared to before the COVID-19 pandemic (37.7 ± 3.3 vs. 21.0 ± 3.0, p = 0.013). On the other hand, in the second half of the period, the number of patients was almost the same during the COVID-19 pandemic compared to before the pandemic (31.8 ± 2.6 vs. 30.3 ± 1.9, p = 0.571)

Fig. 4

Comparison of the mean number of patients with gastric cancer per month diagnosed before and during the COVID-19 pandemic according to treatments for each period. a Endoscopic resection: The number of patients with gastric cancer during the COVID-19 pandemic decreased compared to that before the COVID-19 pandemic (11.8 ± 0.9 vs. 7.7 ± 0.9, p = 0.005) throughout the year. Similarly, the number of patients decreased during the first half of the period during compared to before the COVID-19 pandemic (12.2 ± 1.2 vs. 6.2 ± 1.1, p = 0.013). On the other hand, during the second half of the period, the number of patients was almost the same before and during the COVID-19 pandemic (11.3 ± 1.3 vs. 9.2 ± 1.2, p = 0.295). b Radical gastrectomy: The number of patients with gastric cancer who were treated with radical gastrostomies decreased during the COVID-19 pandemic, compared to before the COVID-19 pandemic (15.9 ± 1.1 vs. 13.2 ± 1.2, p = 0.281) throughout the year. Similarly, the number of patients was decreased in the first half of the period during compared to before the COVID-19 pandemic (17.7 ± 1.9 vs. 10.8 ± 1.8, p = 0.045). On the other hand, in the second half of the period, the number of patients was almost the same during compared to before the COVID-19 pandemic (14.2 ± 1.8 vs. 15.5 ± 1.2, p = 0.416). c Palliative therapy: The number of patients who underwent palliative care during the COVID-19 pandemic did not significantly decrease compared to before the COVID-19 pandemic nor during the first or second halves of the period (7.1 ± 1.0 vs. 4.8 ± 0.6, p = 0.081; 7.8 ± 1.4 vs. 4.0 ± 1.1, p = 0.064; 6.3 ± 1.4 vs. 5.7 ± 0.6, p = 0.468, respectively)