Delayed diagnostic imaging but stable treatment initiation for kidney cancer during the COVID-19 pandemic: a Hungarian cohort study

Background/Objectives: The COVID-19 pandemic influenced cancer care worldwide, delaying diagnosis and treatment. We compared waiting times - time to initial diagnostic imaging, time to treatment, time to histopathological diagnosis, and length of hospital stay - of kidney cancer patients between pre-COVID-19 and COVID-19 periods at a large regional Hungarian clinical center. We also aimed to identify factors predicting prolonged waiting times. Methods: Data from 400 adult kidney cancer patients (all histologically renal cell carcinoma) at the University of Pécs Urology Clinic were analyzed retrospectively, for two periods (1 January 2019-15 March 2020, pre-pandemic; 16 March 2020-13 May 2021, pandemic). Demographic and clinical characteristics were collected, and time intervals calculated from electronic health records, followed by statistical analyses. Results: Median time from symptom onset to initial diagnostic imaging increased significantly from 7.5 to 34 days during the pandemic (p = 0.026), while time to treatment (p = 0.492), time to histopathological diagnosis (p = 0.575), and length of hospital stay (p = 0.319) remained stable. Median healthcare-related waiting times (time to treatment and time to histopathological diagnosis) were comparatively long (range: 95.5-111 days). Advanced-stage disease (III-IV) was protective for prolonged time to initial diagnostic imaging (OR 0.205, 95% CI 0.074-0.568) pre-pandemic and for prolonged time to histopathological diagnosis (OR 0.496, 95% CI 0.254-0.971) during the pandemic. No other demographic or clinical factors influenced waiting times significantly. Conclusion: The pandemic prolonged the interval from symptom onset to initial diagnostic testing, likely due to fear-driven healthcare avoidance by patients, but did not affect healthcare-related waiting times. Advanced-stage disease predicted shorter waiting times, with variable influence across periods. Our findings highlight the need for patient education and careful prioritization of care, with waiting times exceeding those reported in other international settings.