Impact of the COVID-19 pandemic on disease stage and treatment for patients with pancreatic adenocarcinoma: A French comprehensive multicentre ambispective observational cohort study (CAPANCOVID)

Abstract

Background: The COVID-19 pandemic caused major oncology care pathway disruption. The CAPANCOVID study aimed to evaluate the impact on pancreatic adenocarcinoma (PA) - from diagnosis to treatment - of the reorganisation of the health care system during the first lockdown.

Methods: This multicentre ambispective observational study included 833 patients diagnosed with PA between September 1, 2019 and October 31, 2020 from 13 French centres. Data were compared over three periods defined as before the outbreak of COVID-19, during the first lockdown (March 1 to May 11, 2020) and after lockdown.

Results: During the lockdown, mean weekly number of new cases decreased compared with that of pre-pandemic levels (13.2 vs. 10.8, -18.2%; p = 0.63) without rebound in the post-lockdown period (13.2 vs. 12.9, -1.7%; p = 0.97). The number of borderline tumours increased (13.6%-21.7%), whereas the rate of metastatic diseases rate dropped (47.1%-40.3%) (p = 0.046). Time-to-diagnosis and -treatment were not different over periods. Waiting neoadjuvant chemotherapy in resectable tumours was significantly favoured (24.7%-32.6%) compared with upfront surgery (13%-7.8%) (p = 0.013). The use of mFOLFIRINOX preoperative chemotherapy regimen decreased (84.9%-69%; p = 0.044). After lockdown, the number of borderline tumours decreased (21.7%-9.6%) and advanced diseases increased (59.7%-69.8%) (p = 0.046). SARS-CoV-2 infected 39 patients (4.7%) causing 5 deaths (12.8%).

Conclusion: This cohort study suggests the existence of missing diagnoses and of a shift in disease stage at diagnosis from resectable to advanced diseases with related therapeutic modifications whose prognostic consequences will be known after the planned follow-up.

Trial registration: Clinicaltrials.gov NCT04406571.

Keywords: COVID-19; Cancer; Care pathway; Pancreatic neoplasms; Pandemic; SARS-CoV-2.

Conflict of interest statement

Conflict of interest statement D.T. reports personal fees as a speaker and/or in an advisory role from Merck KGaA, Roche, Bayer, Astra-Zeneca, BMS, MSD, Amgen, Sanofi, Servier, Ipsen and Pierre Fabre, outside the submitted work. G.P. reports personal fees as a speaker and/or in an advisory role from BMS, MSD, Stryker and Medtronic, outside the submitted work. A.T. reports personal fees as a speaker and/or in an advisory role from Amgen, Merck KGaA, Servier, Mylan and Pierre Fabre and travel accommodations expenses from Pfizer and Sanofi, outside the submitted work. G.R. reports personal fees as a speaker and/or in an advisory role from Accord Healthcare, Abbvie, Amgen, Ipsen, Sanofi, Servier, and MSD, outside the submitted work. F.D.F. reports personal fees as a speaker and/or in an advisory role from Roche, Amgen, Merck KGaA, Sanofi, Ipsen, Pierre Fabre, Servier, Janssens, Mylan, Sandoz and Bayer, outside the submitted work. C.B. reports personal fees as a speaker and/or in an advisory role from MSD, Sanofi, Bayer and a research grant from Servier, Roche, outside the submitted work. V.M reports personal fees as a speaker and/or in an advisory role from Sanofi, outside the submitted work. A.L. reports personal fees as a speaker and/or in an advisory role from Amgen, Vifor-Pharma, Bayer, Merck KGaA, Sanofi, Ipsen, Servier, Pierre Fabre, a research grant from Roche, and travel accommodation expenses from Abbvie, Amgen, Bayer, MSD, Vifor-Pharma, Mundi Pharma, Ipsen, Novartis outside the submitted work. D.B. reports personal fees as a speaker and/or in an advisory role from Accord Healthcare, Amgen, Sanofi, Servier, and Pierre Fabre, outside the submitted work. C.C. reports personal fees as a speaker from Bristol Myers Squibb, outside the submitted work. O.B. reports personal fees as a speaker and/or in an advisory role from Merck KGaA, Roche, Bayer, Astra-Zeneca, Grunenthal, MSD, Amgen, Sanofi, Servier, and Pierre Fabre, outside the submitted work. All other authors declared no conflicts of interest for this study.

Copyright © 2022 Elsevier Ltd. All rights reserved.

Figures

Fig. 1

Consort diagram.

Fig. 2

Number of new biweekly cases of pancreatic adenocarcinoma based on disease stage at diagnosis (comparison per periods (P0, P1, and P2) using Chi2 tests: p = 0.046).

Fig. 3

Number of new biweekly cases of pancreatic adenocarcinoma based on first therapeutic decision (comparison per periods (P0, P1, and P2) using Chi2 tests: p = 0.013).