Background: We evaluated the impact of COVID-19 on the care pathway and outcomes for patients diagnosed with lung cancer in 2020 in Belgium.
Methods: Lung cancer patients diagnosed in 2017–2020 were extracted from the nationwide Belgian Cancer Registry database. Characteristics and treatment of patients in 2020 were compared with 2017–2019 at semester level (January-June: S1; July-December: S2). 90-day post-operative mortality and relative survival (RS) at 1 and 3 years for 2020 were compared with the 2017–2019 trend.
Results: The study included 29,721 patients diagnosed with lung cancer in 2017–2020. Patients diagnosed in 2020 had a poorer WHO Performance status and more often distant metastases compared to the corresponding semester in 2017–2019. In 2020 S2, there was slightly less surgery performed in patients with early-stage (I-II) lung cancer in favour of radiotherapy (RT) (surgery:4.7 percent-points, RT +6.0 percent-points, p = 0.001). RT courses had a shorter median duration (S1:4 days; S2:4 days) and lower median number of fractions (S1:5; S2:5). The unadjusted 90-day post-operative mortality increased, but this increase was no longer significant when adjusting for case-mix (unadjusted: Odds ratio (OR) =1.85 [1.05–3.24]; adjusted: (OR 1.78 [0.99–3.21]). There was no significant change in RS at 1 and 3 years, with or without case-mix adjustment (unadjusted: 1-year excess hazard ratio (EHR)=1.06 [1.00–1.12], 3-year EHR=1.05 [1.00–1.11]; adjusted: 1-year EHR=1.02 [0.96–1.08], 3-year EHR=1.02 [0.96–1.07]).
Conclusion: Lung cancer patients in Belgium experienced only minor changes in their care pathway during the COVID-19 pandemic. The changes in stage distribution and the increase in 90-day postoperative mortality warrant monitoring of long-term outcomes.