COVID-19 and liver cancer: lost patients and larger tumours
Background Northern England has been experiencing a persistent rise in the number of primary liver cancers, largely driven by an increasing incidence of hepatocellular carcinoma (HCC) secondary to alcohol-related liver disease and non-alcoholic fatty liver disease. Here we review the effect of the C...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2022-07-01
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| Series: | BMJ Open Gastroenterology |
| Online Access: | https://bmjopengastro.bmj.com/content/9/1/e000794.full |
| _version_ | 1797783388577333248 |
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| author | Helen L Reeves Tim Hoare Steven Masson Paul Turner Lucy Walker Quentin M Anstee Stuart McPherson Mhairi Donnelly Preya Patel Beate Haugk Antony Darne John Scott Robyn Watson Jessica Dyson Steven White Gourab Sen Sanjay Pandanaboyana John Hammond Stuart Robinson Jeremy J French Mark Hudson Kirsty Anderson Derek M Manas Peter Littler Daniel Geh Misti McCain Alastair Burt Louise MacDougal Michael McNeil Nick Wadd Syed Asghar Lavanya Mariappan Jane Margetts Yvonne Bury Shreya Raman Daniel Parkinson Benjamin Stenberg |
| author_facet | Helen L Reeves Tim Hoare Steven Masson Paul Turner Lucy Walker Quentin M Anstee Stuart McPherson Mhairi Donnelly Preya Patel Beate Haugk Antony Darne John Scott Robyn Watson Jessica Dyson Steven White Gourab Sen Sanjay Pandanaboyana John Hammond Stuart Robinson Jeremy J French Mark Hudson Kirsty Anderson Derek M Manas Peter Littler Daniel Geh Misti McCain Alastair Burt Louise MacDougal Michael McNeil Nick Wadd Syed Asghar Lavanya Mariappan Jane Margetts Yvonne Bury Shreya Raman Daniel Parkinson Benjamin Stenberg |
| author_sort | Helen L Reeves |
| collection | DOAJ |
| description | Background Northern England has been experiencing a persistent rise in the number of primary liver cancers, largely driven by an increasing incidence of hepatocellular carcinoma (HCC) secondary to alcohol-related liver disease and non-alcoholic fatty liver disease. Here we review the effect of the COVID-19 pandemic on primary liver cancer services and patients in our region.Objective To assess the impact of the COVID-19 pandemic on patients with newly diagnosed liver cancer in our region.Design We prospectively audited our service for the first year of the pandemic (March 2020–February 2021), comparing mode of presentation, disease stage, treatments and outcomes to a retrospective observational consecutive cohort immediately prepandemic (March 2019–February 2020).Results We observed a marked decrease in HCC referrals compared with previous years, falling from 190 confirmed new cases to 120 (37%). Symptomatic became the the most common mode of presentation, with fewer tumours detected by surveillance or incidentally (% surveillance/incidental/symptomatic; 34/42/24 prepandemic vs 27/33/40 in the pandemic, p=0.013). HCC tumour size was larger in the pandemic year (60±4.6 mm vs 48±2.6 mm, p=0.017), with a higher incidence of spontaneous tumour haemorrhage. The number of new cases of intrahepatic cholangiocarcinoma (ICC) fell only slightly, with symptomatic presentation typical. Patients received treatment appropriate for their cancer stage, with waiting times shorter for patients with HCC and unchanged for patients with ICC. Survival was associated with stage both before and during the pandemic. 9% acquired COVID-19 infection.Conclusion The pandemic-associated reduction in referred patients in our region was attributed to the disruption of routine healthcare. For those referred, treatments and survival were appropriate for their stage at presentation. Non-referred or missing patients are expected to present with more advanced disease, with poorer outcomes. While protective measures are necessary during the pandemic, we recommend routine healthcare services continue, with patients encouraged to engage. |
| first_indexed | 2024-03-13T00:25:19Z |
| format | Article |
| id | doaj.art-93c4d1073c934cc8b0678fe34c3b162f |
| institution | Directory Open Access Journal |
| issn | 2054-4774 |
| language | English |
| last_indexed | 2024-03-13T00:25:19Z |
| publishDate | 2022-07-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Gastroenterology |
| spelling | doaj.art-93c4d1073c934cc8b0678fe34c3b162f2023-07-11T07:00:08ZengBMJ Publishing GroupBMJ Open Gastroenterology2054-47742022-07-019110.1136/bmjgast-2021-000794COVID-19 and liver cancer: lost patients and larger tumoursHelen L Reeves0Tim Hoare1Steven Masson2Paul Turner3Lucy Walker4Quentin M Anstee5Stuart McPherson6Mhairi Donnelly7Preya Patel8Beate Haugk9Antony Darne10John Scott11Robyn Watson12Jessica Dyson13Steven White14Gourab Sen15Sanjay Pandanaboyana16John Hammond17Stuart Robinson18Jeremy J French19Mark Hudson20Kirsty Anderson21Derek M Manas22Peter Littler23Daniel Geh24Misti McCain25Alastair Burt26Louise MacDougal27Michael McNeil28Nick Wadd29Syed Asghar30Lavanya Mariappan31Jane Margetts32Yvonne Bury33Shreya Raman34Daniel Parkinson35Benjamin Stenberg36Hepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UKDepartment of Radiology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UKThe Liver Unit, Department of Medicine, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK1 National Heart & Lung Institute, Imperial College London, London, UKThe Liver Unit, Department of Medicine, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UKTranslational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK1The Newcastle Upon Tyne Hospitals Trust, Newcastle Upon Tyne, UKThe Liver Unit, Department of Medicine, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UKLiver Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UKDepartment of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UKDepartment of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UKHepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UKTranslational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UKThe Liver Unit, Department of Medicine, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UKHepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UKHepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UKPopulation Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UKHepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UKHepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UKHepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UKFormerly Liver Unit, Freeman Hospital, Newcastle upon Tyne, UKDepartment of Radiology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UKHepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UKHepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UKTranslational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UKTranslational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UKTranslational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UKHepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UKDepartment of Radiology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UKDepartment of Oncology, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UKDepartment of Oncology, North Cumbria Integrated Care NHS Foundation Trust, Carlisle, UKHepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UKHepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UKDepartment of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UKDepartment of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UKDepartment of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UKDepartment of Radiology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UKBackground Northern England has been experiencing a persistent rise in the number of primary liver cancers, largely driven by an increasing incidence of hepatocellular carcinoma (HCC) secondary to alcohol-related liver disease and non-alcoholic fatty liver disease. Here we review the effect of the COVID-19 pandemic on primary liver cancer services and patients in our region.Objective To assess the impact of the COVID-19 pandemic on patients with newly diagnosed liver cancer in our region.Design We prospectively audited our service for the first year of the pandemic (March 2020–February 2021), comparing mode of presentation, disease stage, treatments and outcomes to a retrospective observational consecutive cohort immediately prepandemic (March 2019–February 2020).Results We observed a marked decrease in HCC referrals compared with previous years, falling from 190 confirmed new cases to 120 (37%). Symptomatic became the the most common mode of presentation, with fewer tumours detected by surveillance or incidentally (% surveillance/incidental/symptomatic; 34/42/24 prepandemic vs 27/33/40 in the pandemic, p=0.013). HCC tumour size was larger in the pandemic year (60±4.6 mm vs 48±2.6 mm, p=0.017), with a higher incidence of spontaneous tumour haemorrhage. The number of new cases of intrahepatic cholangiocarcinoma (ICC) fell only slightly, with symptomatic presentation typical. Patients received treatment appropriate for their cancer stage, with waiting times shorter for patients with HCC and unchanged for patients with ICC. Survival was associated with stage both before and during the pandemic. 9% acquired COVID-19 infection.Conclusion The pandemic-associated reduction in referred patients in our region was attributed to the disruption of routine healthcare. For those referred, treatments and survival were appropriate for their stage at presentation. Non-referred or missing patients are expected to present with more advanced disease, with poorer outcomes. While protective measures are necessary during the pandemic, we recommend routine healthcare services continue, with patients encouraged to engage.https://bmjopengastro.bmj.com/content/9/1/e000794.full |
| spellingShingle | Helen L Reeves Tim Hoare Steven Masson Paul Turner Lucy Walker Quentin M Anstee Stuart McPherson Mhairi Donnelly Preya Patel Beate Haugk Antony Darne John Scott Robyn Watson Jessica Dyson Steven White Gourab Sen Sanjay Pandanaboyana John Hammond Stuart Robinson Jeremy J French Mark Hudson Kirsty Anderson Derek M Manas Peter Littler Daniel Geh Misti McCain Alastair Burt Louise MacDougal Michael McNeil Nick Wadd Syed Asghar Lavanya Mariappan Jane Margetts Yvonne Bury Shreya Raman Daniel Parkinson Benjamin Stenberg COVID-19 and liver cancer: lost patients and larger tumours BMJ Open Gastroenterology |
| title | COVID-19 and liver cancer: lost patients and larger tumours |
| title_full | COVID-19 and liver cancer: lost patients and larger tumours |
| title_fullStr | COVID-19 and liver cancer: lost patients and larger tumours |
| title_full_unstemmed | COVID-19 and liver cancer: lost patients and larger tumours |
| title_short | COVID-19 and liver cancer: lost patients and larger tumours |
| title_sort | covid 19 and liver cancer lost patients and larger tumours |
| url | https://bmjopengastro.bmj.com/content/9/1/e000794.full |
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