The Impact of COVID-19 Within Stage Migration and Upstage in Multiple Cancer Lineages

Background: The COVID-19 pandemic altered access to healthcare. This resulted in fewer number of patients who received cancer screening, prompt evaluation, and management, while delaying diagnosis and treatment of multiple cancer types. Currently, there is limited information on staging trends observed after the COVID-19 pandemic. Therefore, we set to evaluate patterns of disease staging at diagnosis and treatment within multiple cancer types by comparing pre, during and post COVID eras. We seek to understand whether there is a COVID effect on the current guidelines for diagnosis, treatment, and surveillance. Method : We performed a retrospective review from a high-volume, Commission on Cancer certified institute. Cohorts were grouped into three separate eras, Pre-COVID (PreC) (2013-2020), During COVID (DC) (2020-2021), and Post-COVID (PosC) (2021-present). Clinical and pathological stages were compared across the COVID eras amongst breast, colorectal, prostate, lung, pancreas and gastric cancers. Multivariant analysis, factorial ANOVAs, independent t-test, and chi square analysis evaluated statistic relationships, with a p-value of <0.05 noted as significant. Results: Our study population consisted of 16119 individuals with a median age of 67 (SD±12). Staging trends indicated those with breast cancer had a significantly lower clinical stage DC (T1a) and PosC (T1a) compared to PreC era (T1b), ( p <0.05). Conversely, lung cancer indicated a significant clinical upstage DC (T3a) when compared to PreC (T2b) (<0.001) but not during PosC (T2b). Further, there was a significant increase in clinical stage DC (T2b) and PosC (T2b) when compared to PreC (T2a) within prostate cancer (<0.001). Similar trends were reflected in colorectal cancer, to which a significant increase in clinical stage DC (T2b) and PosC (T2b) was observed compared to PreC (T2a) (<0.001). No significant difference in staging for pancreatic and gastric cancer was observed. Conclusion: Significant staging trends were observed throughout the cancer types when comparing PreC, DC, and PosC cohorts, but the trend depended on cancer type. This potentially highlights awareness of a changing population and healthcare system post pandemic depending on cancer types.