Disruption of Radiological Surveillance Following a Global Health Crisis in Resected Lung Cancer

Abstract

Objectives: Radiological surveillance after curative-intent lung cancer resection is essential for early detection of recurrence and second primary tumors. Large-scale health emergencies can compromise oncologic follow-up. This study quantifies the impact of a health crisis on radiological surveillance in a national cohort of resected lung cancer patients.

Methods: A time-segmented observational cohort study was performed using data from the prospective, multicenter GEVATS registry. Surveillance density (CT/month) was evaluated across three predefined periods: pre-pandemic (baseline), state of alarm (maximum healthcare restrictions), and post-alarm (recovery phase). The population at risk was updated for each period. Subgroup analyses during the post-alarm phase assessed prioritization according to neoadjuvant treatment, pathological stage, age, and comorbidity.

Results: Among 2382 eligible patients, surveillance density declined progressively from the pre-pandemic period (0.157 ± 0.079 CT/month) to the state of alarm (0.098 ± 0.071 CT/month). In the post-alarm phase, density dropped sharply to 0.023 ± 0.018 CT/month (equivalent to one CT every 3.6 years), representing a 76.5% reduction compared with the state-of-alarm period (p < 0.001). This under-surveillance was generalized, with no significant differences by pathological stage (p = 0.084), age (p = 0.564), or comorbidity (p = 0.872). Only prior neoadjuvant therapy was associated with a slightly higher density (p = 0.040).

Conclusions: A prolonged health crisis resulted in a profound and persistent reduction in radiological surveillance after lung cancer resection, without evidence of risk-based prioritization. These findings support the need for contingency frameworks within clinical guidelines to preserve continuity of oncologic follow-up during future health emergencies.

Keywords: follow‐up studies; health services; lung neoplasms; thoracic surgery.

FIGURE 1

Flowchart of patient selection for the analysis of the total number of patients in the GEVATS database.

FIGURE 2

Mean density of computed tomography scans per month (CT/month) during postoperative follow‐up of patients with resected lung cancer across the three defined study periods. Red dashed lines indicate the surveillance density recommended by clinical guidelines for each period: 0.167 CT/month (one CT every 6 months) during the pre‐pandemic phase, and 0.083 CT/month (one annual CT) during the state‐of‐alarm and post‐alarm periods. Error bars represent the standard error of the mean.