Comparative inpatient care of cancer vs. non-cancer patients in Switzerland during the national COVID-19 lockdown: a nationwide interrupted time series analysis

Abstract

Background: The COVID-19 pandemic exerted unprecedented pressure on healthcare systems worldwide, leading governments and hospitals to postpone elective procedures to prioritize care for COVID-19 patients. Cancer patients, who often require frequent interactions with hospital services, may have been disproportionately affected by these disuptions in healthcare delivery. This study aimed to analyze and compare hospital care provided to cancer and non-cancer inpatients during the lockdown and post-lockdown periods in Switzerland.

Methods: This study analyzed comprehensive adult acute care inpatient records from national administrative hospital data spanning 2017 to 2021. Using monthly patient-level data, comparative interrupted time series and difference-in-differences analysis were conducted to assess changes in hospital care between patients with and without an ICD-10 cancer diagnosis. Changes in admission volumes, hospital outcomes (length of stay, mortality), and cancer-specific treatments (chemotherapy, radiation therapy, and palliative care) during the lockdown and post-lockdown phases of the pandemic were analyzed.

Results: Hospital admissions decreased substantially during the lockdown period. From March to May 2020, non-cancer patients experienced a reduction of 17'368 admissions (-18%) (95% CI [-24'333, -10'402]), compared with a reduction of 966 admissions (-9%) (95% CI [-1'636, -296]) for cancer patients. However, despite reduction in admissions, cancer inpatients received critical treatments at rates that were no lower for chemotherapy, and 6% (95% CI [1, 12]) and 15.2% (95% CI [10; 20]) higher for radiation therapy and palliative care, respectively, during the lockdown period compared to pre-pandemic levels. The mortality rate for both groups increased during the lockdown, but the rise was 22% (95% CI [8, 32]) smaller for cancer patients compared to non-cancer patients. The length of stay increased for both groups during the lockdown. However, the difference in length of stay between cancer and non-cancer patients vanished during the lockdown, with a higher length of stay of only 0.06 days (95% CI [-0.05, 0.18]) for cancer patients, compared to 0.40 days (95% CI [0.37, 0.43]) before the lockdown.

Conclusion: Swiss hospitals were able to maintain access to cancer services during the pandemic, mitigating the impact of the COVID-19 crisis for cancer population. These findings contribute to highlight the resilience of healthcare systems and understand decision-making processes during public health emergencies. However, long-term consequences of reduced care for cancer patients warrants further investigation.

Keywords: Administrative data; Cancer; Chemotherapy; Comparative Time Series; Covid-19; Hospital; ICD-10; Interrupted Time Series Analysis; Lockdown; Radiation therapy; Routinely-Collected Health Data; Switzerland.

Fig. 1

Monthly hospital admissions for cancer and non-cancer patients in Switzerland between January 2017 and February 2021. During the lockdown period, the differences in admission volumes between cancer and non-cancer patients were similarly observed within subgroups of older patients, female patients, patients with comorbidities, and those admitted to university hospitals as shown by subgroup explorations (Supplementary material 3.2). In the post-lockdown period, the difference in the reduction in admissions between cancer and non-cancer patients persisted in these subgroups but became smaller, except in the middle-aged group (65–80 years) for which no statistically significant difference in admission volume was observed between cancer and non-cancer patients