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Impact of the COVID-19 pandemic on lung cancer diagnosis, treatment, mortality, and survival in Belgium: A population-based study
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DOI：10.1016/j.resmer.2025.101205.png)
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Abstract
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Background: We evaluated the impact of COVID-19 on the care pathway and outcomes for patients diagnosed with lung cancer in 2020 in Belgium. Methods: Lung cancer patients diagnosed in 2017-2020 were extracted from the nationwide Belgian Cancer Registry database. Characteristics and treatment of patients in 2020 were compared with 2017-2019 at semester level (January-June: S1; July-December: S2). 90-day post-operative mortality and relative survival (RS) at 1 and 3 years for 2020 were compared with the 2017-2019 trend. Results: The study included 29,721 patients diagnosed with lung cancer in 2017-2020. Patients diagnosed in 2020 had a poorer WHO Performance status and more often distant metastases compared to the corresponding semester in 2017-2019. In 2020 S2, there was slightly less surgery performed in patients with early-stage (I-II) lung cancer in favour of radiotherapy (RT) (surgery:4.7 percent-points, RT +6.0 percent-points, p = 0.001). RT courses had a shorter median duration (S1:4 days; S2:4 days) and lower median number of fractions (S1:5; S2:5). The unadjusted 90-day post-operative mortality increased, but this increase was no longer significant when adjusting for case-mix (unadjusted: Odds ratio (OR) =1.85 [1.05-3.24]; adjusted: (OR 1.78 [0.99-3.21]). There was no significant change in RS at 1 and 3 years, with or without case-mix adjustment (unadjusted: 1-year excess hazard ratio (EHR)=1.06 [1.00-1.12], 3-year EHR=1.05 [1.00-1.11]; adjusted: 1-year EHR=1.02 [0.96 -1.08], 3-year EHR=1.02 [0.96-1.07]). Conclusion: Lung cancer patients in Belgium experienced only minor changes in their care pathway during the COVID-19 pandemic. The changes in stage distribution and the increase in 90-day postoperative mortality warrant monitoring of long-term outcomes.
Keywords:
COVID-19
Lung cancer
Time-to-treatment
Post-operative mortality
Relative survival
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