The Impact of the COVID-19 Pandemic on Head and Neck Cancer Diagnosis in the Piedmont Region, Italy: Interrupted Time-Series Analysis
BackgroundThe COVID-19 pandemic has likely affected the most vulnerable groups of patients and those requiring time-critical access to healthcare services, such as patients with cancer. The aim of this study was to use time trend data to assess the impact of COVID-19 on timely diagnosis and treatmen...
| Main Authors: | , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2022-02-01
|
| Series: | Frontiers in Public Health |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fpubh.2022.809283/full |
| _version_ | 1819320136994127872 |
|---|---|
| author | Maja Popovic Maja Popovic Valentina Fiano Valentina Fiano Giovenale Moirano Giovenale Moirano Luigi Chiusa David I. Conway Paolo Garzino Demo Marco Gilardetti Giuseppe Carlo Iorio Chiara Moccia Chiara Moccia Oliviero Ostellino Giancarlo Pecorari Guglielmo Ramieri Umberto Ricardi Giuseppe Riva Shama Virani Lorenzo Richiardi Lorenzo Richiardi |
| author_facet | Maja Popovic Maja Popovic Valentina Fiano Valentina Fiano Giovenale Moirano Giovenale Moirano Luigi Chiusa David I. Conway Paolo Garzino Demo Marco Gilardetti Giuseppe Carlo Iorio Chiara Moccia Chiara Moccia Oliviero Ostellino Giancarlo Pecorari Guglielmo Ramieri Umberto Ricardi Giuseppe Riva Shama Virani Lorenzo Richiardi Lorenzo Richiardi |
| author_sort | Maja Popovic |
| collection | DOAJ |
| description | BackgroundThe COVID-19 pandemic has likely affected the most vulnerable groups of patients and those requiring time-critical access to healthcare services, such as patients with cancer. The aim of this study was to use time trend data to assess the impact of COVID-19 on timely diagnosis and treatment of head and neck cancer (HNC) in the Italian Piedmont region.MethodsThis study was based on two different data sources. First, regional hospital discharge register data were used to identify incident HNC in patients ≥18 years old during the period from January 1, 2015, to December 31, 2020. Interrupted time-series analysis was used to model the long-time trends in monthly incident HNC before COVID-19 while accounting for holiday-related seasonal fluctuations in the HNC admissions. Second, in a population of incident HNC patients eligible for recruitment in an ongoing clinical cohort study (HEADSpAcE) that started before the COVID-19 pandemic, we compared the distribution of early-stage and late-stage diagnoses between the pre-COVID-19 and the COVID-19 period.ResultsThere were 4,811 incident HNC admissions in the 5-year period before the COVID-19 outbreak and 832 admissions in 2020, of which 689 occurred after the COVID-19 outbreak in Italy. An initial reduction of 28% in admissions during the first wave of the COVID-19 pandemic (RR 0.72, 95% CI 0.62–0.84) was largely addressed by the end of 2020 (RR 0.96, 95% CI 0.89–1.03) when considering the whole population, although there were some heterogeneities. The gap between observed and expected admissions was particularly evident and had not completely recovered by the end of the year in older (≥75 years) patients (RR: 0.88, 0.76–1.01), patients with a Romano-Charlson comorbidity index below 2 (RR 0.91, 95% CI: 0.84–1.00), and primary surgically treated patients (RR 0.88, 95% CI 0.80–0.97). In the subgroup of patients eligible for the ongoing active recruitment, we observed no evidence of a shift toward a more advanced stage at diagnosis in the periods following the first pandemic wave.ConclusionsThe COVID-19 pandemic has affected differentially the management of certain groups of incident HNC patients, with more pronounced impact on older patients, those treated primarily surgically, and those with less comorbidities. The missed and delayed diagnoses may translate into worser oncological outcomes in these patients. |
| first_indexed | 2024-12-24T11:14:47Z |
| format | Article |
| id | doaj.art-4c295eec1ef04e9683ccfb62af950bcf |
| institution | Directory Open Access Journal |
| issn | 2296-2565 |
| language | English |
| last_indexed | 2024-12-24T11:14:47Z |
| publishDate | 2022-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Public Health |
| spelling | doaj.art-4c295eec1ef04e9683ccfb62af950bcf2022-12-21T16:58:25ZengFrontiers Media S.A.Frontiers in Public Health2296-25652022-02-011010.3389/fpubh.2022.809283809283The Impact of the COVID-19 Pandemic on Head and Neck Cancer Diagnosis in the Piedmont Region, Italy: Interrupted Time-Series AnalysisMaja Popovic0Maja Popovic1Valentina Fiano2Valentina Fiano3Giovenale Moirano4Giovenale Moirano5Luigi Chiusa6David I. Conway7Paolo Garzino Demo8Marco Gilardetti9Giuseppe Carlo Iorio10Chiara Moccia11Chiara Moccia12Oliviero Ostellino13Giancarlo Pecorari14Guglielmo Ramieri15Umberto Ricardi16Giuseppe Riva17Shama Virani18Lorenzo Richiardi19Lorenzo Richiardi20Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, ItalySC Epidemiologia dei Tumori CRPT U, Azienda Ospedaliero-Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, Centro di Riferimento per l'Epidemiologia e la Prevenzione Oncologica (CPO) Piemonte, Turin, ItalyCancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, ItalySC Epidemiologia dei Tumori CRPT U, Azienda Ospedaliero-Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, Centro di Riferimento per l'Epidemiologia e la Prevenzione Oncologica (CPO) Piemonte, Turin, ItalyCancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, ItalySC Epidemiologia dei Tumori CRPT U, Azienda Ospedaliero-Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, Centro di Riferimento per l'Epidemiologia e la Prevenzione Oncologica (CPO) Piemonte, Turin, ItalyPathology Unit, Azienda Ospedaliero-Universitaria (A.O.U.) Città della Salute e della Scienza Hospital, Turin, ItalySchool of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, United KingdomMaxillofacial Unit, Azienda Ospedaliero-Universitaria (A.O.U.) Città della Salute e della Scienza Hospital, Turin, ItalySC Epidemiologia dei Tumori CRPT U, Azienda Ospedaliero-Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, Centro di Riferimento per l'Epidemiologia e la Prevenzione Oncologica (CPO) Piemonte, Turin, ItalyDepartment of Oncology, University of Turin, Turin, ItalyCancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, ItalySC Epidemiologia dei Tumori CRPT U, Azienda Ospedaliero-Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, Centro di Riferimento per l'Epidemiologia e la Prevenzione Oncologica (CPO) Piemonte, Turin, ItalyOncology Unit, Azienda Ospedaliero-Universitaria (A.O.U.) Città della Salute e della Scienza Hospital, Turin, ItalyDivision of Otorhinolaryngology, Department of Surgical Sciences, University of Turin, Turin, ItalyMaxillofacial Unit, Azienda Ospedaliero-Universitaria (A.O.U.) Città della Salute e della Scienza Hospital, Turin, ItalyDepartment of Oncology, University of Turin, Turin, ItalyDivision of Otorhinolaryngology, Department of Surgical Sciences, University of Turin, Turin, ItalyGenomic Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, FranceCancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, ItalySC Epidemiologia dei Tumori CRPT U, Azienda Ospedaliero-Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, Centro di Riferimento per l'Epidemiologia e la Prevenzione Oncologica (CPO) Piemonte, Turin, ItalyBackgroundThe COVID-19 pandemic has likely affected the most vulnerable groups of patients and those requiring time-critical access to healthcare services, such as patients with cancer. The aim of this study was to use time trend data to assess the impact of COVID-19 on timely diagnosis and treatment of head and neck cancer (HNC) in the Italian Piedmont region.MethodsThis study was based on two different data sources. First, regional hospital discharge register data were used to identify incident HNC in patients ≥18 years old during the period from January 1, 2015, to December 31, 2020. Interrupted time-series analysis was used to model the long-time trends in monthly incident HNC before COVID-19 while accounting for holiday-related seasonal fluctuations in the HNC admissions. Second, in a population of incident HNC patients eligible for recruitment in an ongoing clinical cohort study (HEADSpAcE) that started before the COVID-19 pandemic, we compared the distribution of early-stage and late-stage diagnoses between the pre-COVID-19 and the COVID-19 period.ResultsThere were 4,811 incident HNC admissions in the 5-year period before the COVID-19 outbreak and 832 admissions in 2020, of which 689 occurred after the COVID-19 outbreak in Italy. An initial reduction of 28% in admissions during the first wave of the COVID-19 pandemic (RR 0.72, 95% CI 0.62–0.84) was largely addressed by the end of 2020 (RR 0.96, 95% CI 0.89–1.03) when considering the whole population, although there were some heterogeneities. The gap between observed and expected admissions was particularly evident and had not completely recovered by the end of the year in older (≥75 years) patients (RR: 0.88, 0.76–1.01), patients with a Romano-Charlson comorbidity index below 2 (RR 0.91, 95% CI: 0.84–1.00), and primary surgically treated patients (RR 0.88, 95% CI 0.80–0.97). In the subgroup of patients eligible for the ongoing active recruitment, we observed no evidence of a shift toward a more advanced stage at diagnosis in the periods following the first pandemic wave.ConclusionsThe COVID-19 pandemic has affected differentially the management of certain groups of incident HNC patients, with more pronounced impact on older patients, those treated primarily surgically, and those with less comorbidities. The missed and delayed diagnoses may translate into worser oncological outcomes in these patients.https://www.frontiersin.org/articles/10.3389/fpubh.2022.809283/fullCOVID-19head and neckcancer detectionItalyinterrupted time-series analysis (ITSA)time trend analyses |
| spellingShingle | Maja Popovic Maja Popovic Valentina Fiano Valentina Fiano Giovenale Moirano Giovenale Moirano Luigi Chiusa David I. Conway Paolo Garzino Demo Marco Gilardetti Giuseppe Carlo Iorio Chiara Moccia Chiara Moccia Oliviero Ostellino Giancarlo Pecorari Guglielmo Ramieri Umberto Ricardi Giuseppe Riva Shama Virani Lorenzo Richiardi Lorenzo Richiardi The Impact of the COVID-19 Pandemic on Head and Neck Cancer Diagnosis in the Piedmont Region, Italy: Interrupted Time-Series Analysis Frontiers in Public Health COVID-19 head and neck cancer detection Italy interrupted time-series analysis (ITSA) time trend analyses |
| title | The Impact of the COVID-19 Pandemic on Head and Neck Cancer Diagnosis in the Piedmont Region, Italy: Interrupted Time-Series Analysis |
| title_full | The Impact of the COVID-19 Pandemic on Head and Neck Cancer Diagnosis in the Piedmont Region, Italy: Interrupted Time-Series Analysis |
| title_fullStr | The Impact of the COVID-19 Pandemic on Head and Neck Cancer Diagnosis in the Piedmont Region, Italy: Interrupted Time-Series Analysis |
| title_full_unstemmed | The Impact of the COVID-19 Pandemic on Head and Neck Cancer Diagnosis in the Piedmont Region, Italy: Interrupted Time-Series Analysis |
| title_short | The Impact of the COVID-19 Pandemic on Head and Neck Cancer Diagnosis in the Piedmont Region, Italy: Interrupted Time-Series Analysis |
| title_sort | impact of the covid 19 pandemic on head and neck cancer diagnosis in the piedmont region italy interrupted time series analysis |
| topic | COVID-19 head and neck cancer detection Italy interrupted time-series analysis (ITSA) time trend analyses |
| url | https://www.frontiersin.org/articles/10.3389/fpubh.2022.809283/full |
| work_keys_str_mv | AT majapopovic theimpactofthecovid19pandemiconheadandneckcancerdiagnosisinthepiedmontregionitalyinterruptedtimeseriesanalysis AT majapopovic theimpactofthecovid19pandemiconheadandneckcancerdiagnosisinthepiedmontregionitalyinterruptedtimeseriesanalysis AT valentinafiano theimpactofthecovid19pandemiconheadandneckcancerdiagnosisinthepiedmontregionitalyinterruptedtimeseriesanalysis AT valentinafiano theimpactofthecovid19pandemiconheadandneckcancerdiagnosisinthepiedmontregionitalyinterruptedtimeseriesanalysis AT giovenalemoirano theimpactofthecovid19pandemiconheadandneckcancerdiagnosisinthepiedmontregionitalyinterruptedtimeseriesanalysis AT giovenalemoirano theimpactofthecovid19pandemiconheadandneckcancerdiagnosisinthepiedmontregionitalyinterruptedtimeseriesanalysis AT luigichiusa theimpactofthecovid19pandemiconheadandneckcancerdiagnosisinthepiedmontregionitalyinterruptedtimeseriesanalysis AT davidiconway theimpactofthecovid19pandemiconheadandneckcancerdiagnosisinthepiedmontregionitalyinterruptedtimeseriesanalysis AT paologarzinodemo theimpactofthecovid19pandemiconheadandneckcancerdiagnosisinthepiedmontregionitalyinterruptedtimeseriesanalysis AT marcogilardetti theimpactofthecovid19pandemiconheadandneckcancerdiagnosisinthepiedmontregionitalyinterruptedtimeseriesanalysis AT giuseppecarloiorio theimpactofthecovid19pandemiconheadandneckcancerdiagnosisinthepiedmontregionitalyinterruptedtimeseriesanalysis AT chiaramoccia theimpactofthecovid19pandemiconheadandneckcancerdiagnosisinthepiedmontregionitalyinterruptedtimeseriesanalysis AT chiaramoccia theimpactofthecovid19pandemiconheadandneckcancerdiagnosisinthepiedmontregionitalyinterruptedtimeseriesanalysis AT olivieroostellino theimpactofthecovid19pandemiconheadandneckcancerdiagnosisinthepiedmontregionitalyinterruptedtimeseriesanalysis AT giancarlopecorari theimpactofthecovid19pandemiconheadandneckcancerdiagnosisinthepiedmontregionitalyinterruptedtimeseriesanalysis AT guglielmoramieri theimpactofthecovid19pandemiconheadandneckcancerdiagnosisinthepiedmontregionitalyinterruptedtimeseriesanalysis AT umbertoricardi theimpactofthecovid19pandemiconheadandneckcancerdiagnosisinthepiedmontregionitalyinterruptedtimeseriesanalysis AT giusepperiva theimpactofthecovid19pandemiconheadandneckcancerdiagnosisinthepiedmontregionitalyinterruptedtimeseriesanalysis AT shamavirani theimpactofthecovid19pandemiconheadandneckcancerdiagnosisinthepiedmontregionitalyinterruptedtimeseriesanalysis AT lorenzorichiardi theimpactofthecovid19pandemiconheadandneckcancerdiagnosisinthepiedmontregionitalyinterruptedtimeseriesanalysis AT lorenzorichiardi theimpactofthecovid19pandemiconheadandneckcancerdiagnosisinthepiedmontregionitalyinterruptedtimeseriesanalysis AT majapopovic impactofthecovid19pandemiconheadandneckcancerdiagnosisinthepiedmontregionitalyinterruptedtimeseriesanalysis AT majapopovic impactofthecovid19pandemiconheadandneckcancerdiagnosisinthepiedmontregionitalyinterruptedtimeseriesanalysis AT valentinafiano impactofthecovid19pandemiconheadandneckcancerdiagnosisinthepiedmontregionitalyinterruptedtimeseriesanalysis AT valentinafiano impactofthecovid19pandemiconheadandneckcancerdiagnosisinthepiedmontregionitalyinterruptedtimeseriesanalysis AT giovenalemoirano impactofthecovid19pandemiconheadandneckcancerdiagnosisinthepiedmontregionitalyinterruptedtimeseriesanalysis AT giovenalemoirano impactofthecovid19pandemiconheadandneckcancerdiagnosisinthepiedmontregionitalyinterruptedtimeseriesanalysis AT luigichiusa impactofthecovid19pandemiconheadandneckcancerdiagnosisinthepiedmontregionitalyinterruptedtimeseriesanalysis AT davidiconway impactofthecovid19pandemiconheadandneckcancerdiagnosisinthepiedmontregionitalyinterruptedtimeseriesanalysis AT paologarzinodemo impactofthecovid19pandemiconheadandneckcancerdiagnosisinthepiedmontregionitalyinterruptedtimeseriesanalysis AT marcogilardetti impactofthecovid19pandemiconheadandneckcancerdiagnosisinthepiedmontregionitalyinterruptedtimeseriesanalysis AT giuseppecarloiorio impactofthecovid19pandemiconheadandneckcancerdiagnosisinthepiedmontregionitalyinterruptedtimeseriesanalysis AT chiaramoccia impactofthecovid19pandemiconheadandneckcancerdiagnosisinthepiedmontregionitalyinterruptedtimeseriesanalysis AT chiaramoccia impactofthecovid19pandemiconheadandneckcancerdiagnosisinthepiedmontregionitalyinterruptedtimeseriesanalysis AT olivieroostellino impactofthecovid19pandemiconheadandneckcancerdiagnosisinthepiedmontregionitalyinterruptedtimeseriesanalysis AT giancarlopecorari impactofthecovid19pandemiconheadandneckcancerdiagnosisinthepiedmontregionitalyinterruptedtimeseriesanalysis AT guglielmoramieri impactofthecovid19pandemiconheadandneckcancerdiagnosisinthepiedmontregionitalyinterruptedtimeseriesanalysis AT umbertoricardi impactofthecovid19pandemiconheadandneckcancerdiagnosisinthepiedmontregionitalyinterruptedtimeseriesanalysis AT giusepperiva impactofthecovid19pandemiconheadandneckcancerdiagnosisinthepiedmontregionitalyinterruptedtimeseriesanalysis AT shamavirani impactofthecovid19pandemiconheadandneckcancerdiagnosisinthepiedmontregionitalyinterruptedtimeseriesanalysis AT lorenzorichiardi impactofthecovid19pandemiconheadandneckcancerdiagnosisinthepiedmontregionitalyinterruptedtimeseriesanalysis AT lorenzorichiardi impactofthecovid19pandemiconheadandneckcancerdiagnosisinthepiedmontregionitalyinterruptedtimeseriesanalysis |