Impact of the COVID-19 pandemic on suspected lung cancer referrals and subsequent lung cancer diagnosis at North Bristol NHS Trust

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Introduction: COVID-19 posed an unprecedented challenge to NHS services. A report by the UK Lung Cancer Coalition in October 2020 suggested lung cancer was disproportionately affected,due to overlapping symptoms with COVID-19 and pressures on respiratory services during the pandemic. We investigated the impact of COVID-19 on lung cancer diagnoses in our hospital. Methods: We reviewed all two-week-wait (TWW) suspected lung cancer referrals over two periods; March 2020-February 2021 (pandemic cohort) and January-December 2019 (pre-COVID cohort). Results: Overall, there were fewer referrals to the lung cancer TWW service in 12 months of the COVID pandemic compared with 2019 (469 vs 502). Reductions in referral numbers correlated with local peaks in COVID diagnoses, (see Figure 1, noting reduced COVID testing capacity during the early pandemic). A similar proportion of referrals resulted in a diagnosis of lung cancer in both groups (142/469; 30.8% vs 150/502; 29.8%, p=0.32). Of people diagnosed with lung cancer during the COVID pandemic, more were performance status 2 or higher compared with pre-pandemic (60/142; 42.3% vs 35/137; 25.6%, p=0.003). Additionally, more stage IV (61/141; 61% vs 48/140; 34.3%) and fewer stage I (36/141; 25.5% vs 43/140; 30.7%) tumours were diagnosed (p=0.046) in the pandemic cohort. Conclusion: Our observations replicate national patterns and highlight the serious impact the pandemic has had. Several unavoidable factors were responsible: similarity of cancer and COVID symptoms,reduced access to healthcare due to competing pressures, and ‘shielding’ of people at high risk of lung cancer impacting on number of healthcare interactions.

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