Lockdown Took Down Lung Cancer Diagnoses

Lung cancer incidence in England fell 26% during the first COVID-19 lockdown in comparison to the same time the prior year, researchers found.

Incidence of non-small cell lung cancer (NSCLC) was reduced by 23% and of small cell lung cancer (SCLC) by 45% during that initial national lockdown from March 26 to May 10, 2020, reported Savannah Gysling, PhD, of the University of Nottingham in England, and coauthors.

Incidence rates of lung cancer nearly recovered to their pre-lockdown baseline by the end of 2020 (adjusted IRR 0.96, 95% CI 0.94-0.98), but without a compensatory rise to cover diagnoses that might have been missed during the lockdown.

Not surprisingly, the proportion of lung cancer patients diagnosed at stage IV increased by a mean of 2.2 percentage points after the lockdown was lifted, compared with an equivalent period in 2019, according to the report published in CHEST.

“Currently, there is no national population-based lung cancer screening program to support early diagnosis in the United Kingdom, and lung cancer diagnosis commonly relies on the self-presentation of the patient or an incidental finding,” wrote Gysling and coauthors. “The COVID-19 pandemic represented a unique barrier regarding patient access to lung cancer services and early diagnosis. Throughout several national lockdowns in England, the population has been asked to remain at home and self-isolate with new respiratory symptoms suggestive of viral infection. Simultaneously, healthcare resources were adapted, redeployed, and focused on managing COVID-19.”

Those findings mirrored a prior U.S. study in which diagnoses dropped from March 1 to April 18, 2020, across several types of cancer, including lung cancer.

In speaking to MedPage Today, Harvey Kaufman, MD, of Quest Diagnostics and an author on the U.S. study, emphasized the importance of re-engaging with regular healthcare that may have been paused as a result of the pandemic.

“We avoid healthcare at our own peril,” Kaufman told MedPage Today. “It’s important to have these conditions diagnosed at the earliest stage as possible. If not, there will be people who will present with more advanced stages, require more aggressive therapy, and have worse outcomes.”

Data for Gysling’s study were taken from the U.K. National Lung Cancer Audit’s Rapid Cancer Registration Datasets, with records on a total of 64,457 patients diagnosed with lung cancer from 2019 through 2020.

“The first national lockdown was chosen as the focus of this study, as the restrictions implemented during this lockdown period were the most stringent of those imposed throughout the year, and public motivation for compliance was high,” the researchers noted.

The greatest incidence drop was during May 2020, with 32% fewer lung cancers diagnosed overall compared with May 2019 (adjusted IRR 0.68, 95% CI 0.64-0.72). The rate had been slowly climbing in 2020 before the lockdown (age- and sex-adjusted IRR 1.04 vs 2019, 95% CI 1.01-1.08).

Limitations to the study included some missing data for the smoking status of individuals and the exclusion of lung cancer that was identified through a death certificate registration.

This study follows several others from Canada, Spain, Ireland, and Italy, all of which also showed decreased rates of lung cancer diagnosis or shifts in the stages at which these cancers were identified.

“The pandemic has illustrated what happens when access to prompt diagnosis is severely limited,” Gysling’s group wrote. “As the pandemic continues, it is vital that awareness campaigns are enhanced and linked to prompt access to clinical triage, early diagnosis and appropriate treatment to mitigate excess mortality in a cancer that causes almost a fifth of cancer deaths.”

While the study covered the period up to Dec. 31, 2020, further changes are possible since then, commented Jason Agulnik, MD, of the Peter Brojde Lung Cancer Centre at Jewish General Hospital in Montreal.

“I think that with the initial wave, the fear was mortality,” Agulnik told MedPage Today.

With the lifting of restrictions but more transmissible variants like XBB.1.5, “you’re going to see an uptick in patients in the hospitals, and that will affect certain things like surgery, but I don’t think it’s going to change the number of patients coming through our doors. I do think it will delay certain treatments.”

His group had published in 2021 on a similar 34.7% decline in lung cancer cases in Canada during 2020, along with an 18% decrease in lung cancer surgeries and an increase in waiting times for surgery.