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. 2023 Dec 6;15(24):5729.
doi: 10.3390/cancers15245729.

A Comparative Multicenter Cohort Study Evaluating the Long-Term Influence of the Strict Lockdown during the First COVID-19 Wave on Lung Cancer Patients (ARTEMISIA Trial)

Olivier Molinier  1 , Camille Guguen  1 , Marie Marcq  2 , Anne-Laure Chene  3 , Philippe Masson  4 , Frédéric Bigot  5 , Fabrice Denis  6 , Fabienne Empereur  7 , Philippe Saulnier  8 , Thierry Urban  9
Affiliations

A Comparative Multicenter Cohort Study Evaluating the Long-Term Influence of the Strict Lockdown during the First COVID-19 Wave on Lung Cancer Patients (ARTEMISIA Trial)

Olivier Molinier et al. Cancers (Basel). .

Abstract

The consequences of the strict health restrictions during the first wave of COVID-19 on lung cancer (LC) patients are not known. This cohort study evaluated the impact of the initial lockdown on management of and long-term outcome in LC patients. This exposed-unexposed-type study included two evaluation periods of 6 months each in non-selected patients; one began on the first day of lockdown in 2020, and the other in 2019 during the same calendar period. Various indicators were compared: clinical profiles, management delays and overall survival beyond 2 years. A total of 816 patients from 7 public or private centers were enrolled. The clinical characteristics of the patients in 2020 did not differ from those in 2019, except that the population was older (p = 0.002) with more non-smokers (p = 0.006). Delays for pre-therapeutic medical management were generally reduced after the first imaging in 2020 (1.28 [1.1-1.49]). In the multivariate analysis, being part of the 2020 cohort was correlated with better prognosis (HR = 0.71 [0.5-0.84], p < 0.001). The gain observed in 2020 mainly benefited non-smoking patients, along with ECOG PS 0-2 (p = 0.01), stage 4 (p = 0.003), squamous cell carcinoma (p = 0.03) and receiving systemic therapy (p = 0.03). In conclusion, the first lockdown did not exert any deleterious impact on LC patients.

Keywords: COVID-19; epidemiology; lung neoplasms; quality of healthcare; real-world.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Definitions of management delays. MCC: multidisciplinary cancer conference.
Figure 2
Figure 2
Patient selection. MCCs: multidisciplinary cancer conferences, LC: lung cancer.
Figure 3
Figure 3
Moving average of monthly lung cancer case diagnoses within the two cohorts.
Figure 4
Figure 4
Subgroup analysis of delay 1, defined as the time frame from first symptoms to first imaging. Non-smokers: patients who smoked fewer than 100 cigarettes in their lifetime, Former smokers: patients declaring smoking cessation since at least 1 year prior to diagnosis, ECOG PS: Eastern Cooperative Oncology Group performance status, HR: hazard ratio, CI: confidence interval.
Figure 5
Figure 5
Subgroup analysis of delay 6, defined as the time frame from the first suspicion of lung cancer (date of first imaging) to the date of first treatment. CCC: cancer comprehensive center, SCC: squamous-cell carcinoma, LCNEC: large-cell neuroendocrine carcinoma, SCLC: small-cell lung cancer, LCC Nos: large-cell carcinoma, not otherwise specified, HR: hazard ratio, CI: confidence interval.
Figure 6
Figure 6
Overall survival. Tick marks indicate censored data.
Figure 7
Figure 7
Subgroup analysis for overall survival.
Figure 8
Figure 8
Progression-free survival in treated patients. Tick marks indicate censored data.
See this image and copyright information in PMC

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