Ongoing Implications of the COVID‐19 Pandemic Environment on Esophageal Cancer Characteristics and Treatment in the United States

BACKGROUND: The first year of the COVID-19 pandemic significantly impacted the characteristics and care of esophageal cancer patients. We aimed to assess for continued implications of the altered healthcare landscape on esophageal cancer presentation and treatment in the second year of the pandemic. METHODS: This was a retrospective review of the United States National Cancer Database (2019-2021). Characteristics were compared between patients diagnosed in the pre-pandemic year (2019), pandemic-year-one (2020) and pandemic-year-two (2021). Multivariable risk-adjustment was performed. RESULTS: Of 41 807 esophageal cancer cases, 14 127 (35.3%) were pre-pandemic, 13 975 (32.7%) were pandemic-year-one, and 13 705 (32.0%) were pandemic-year-two. Compared to the pre-pandemic year, patients diagnosed in pandemic-year-two had risk-adjusted increases in time to first course treatment (1.06 [1.04-1.08]), to radiation (1.03 [1.01-1.05]), and to systemic therapy (1.04 [1.02-1.05]). When compared to pandemic-year-one, patients in pandemic-year-two continued to experience additional risk-adjusted increases in time to first course therapy (1.08 [1.06-1.11]), to surgery (1.05 [1.00-1.10]), to radiation (1.05 [1.02-1.07]) and to systemic therapy (1.06 [1.04-1.08]). CONCLUSIONS: Compared to the pre-pandemic year, patients diagnosed with esophageal cancer in in the United States during pandemic-year-two experienced delays to treatment, possibly due to a growing back log of cases.