key: cord-0793459-uswphsaj
authors: Veiga, José; Amante, Sofia; Costa, Nuno Vasco; Luz, José Hugo; Gomes, Filipe Veloso; Coimbra, Élia; Bilhim, Tiago
title: The Covid-19 Pandemic Constraints May Lead to Disease Progression for Patients with Liver Cancer Scheduled to Receive Locoregional Therapies: Single-Centre Retrospective Analysis in an Interventional Radiology Unit
date: 2021-01-27
journal: Cardiovasc Intervent Radiol
DOI: 10.1007/s00270-021-02774-9
sha: 9eae58f8adba5a16e93734c6f78801712da0022c
doc_id: 793459
cord_uid: uswphsaj

nan

The lockdown period (LDP) due to the Covid-19 pandemic was declared in Portugal from the 18 March until the 2 May 2020 [1] , causing a reduction/suspension in non-urgent medical care during this period. Previous studies have confirmed the negative impact of the LDP in the workload at different Interventional Radiology (IR) units across Europe [2, 3] . However, the potential impact on disease progression for oncology patients scheduled for loco-regional therapies (LRT) is mainly unknown, hence this report, which is a single-centre retrospective analysis on the impact of Covid-19 pandemic in an IR Unit. Institutional Review Board approval for the retrospective analysis of data was obtained. Descriptive statistical analyses were used to compare 2019 (non-COVID) and 2020 (COVID) data.

Comparing the total procedure numbers in the LDP (n = 77) with the homologous time-period in 2019 (n = 172), there was a reduction in the overall number of procedures by 55.2%. When comparing the type of procedures (elective/urgent), there was a significant difference, with 33.1% (n = 57) urgent procedures in 2019 versus 48.1% (n = 37) urgent procedures in 2020 (p = 0.0120). The volume reduction in procedures performed was more pronounced for liver transarterial chemoembolization (TACE) (80.0% reduction), microwave ablation (MWA) (75.0% reduction) and percutaneous biopsies (65.2% reduction). The greatest reduction in oncological loco-regional treatments was noted during the LDP [1] , with a gradual recovery after that (Fig. 1) .

The main analysis of this study was to assess the impact on disease progression for all liver oncology patients treated with LRTs after the LDP. All patients that had a scheduled LRT (74 hepatocellular carcinoma, HCC and 10 liver metastases) between 2 May and 16 July 2020 (post LDP) were compared with the homologous period in 2019 (68 HCC and 11 liver metastases). Tables 1 and 2 compare the baseline data of HCC and liver metastases patients treated at this IR unit in the post LDP with the homologous period in 2019. In 2020, HCC patients had significantly higher model of end-stage liver disease (MELD) scores (p = 0.0124) and significantly larger tumours (mean difference of 8.7 mm, p = 0.0071), reflecting more disease burden on the diagnosis. Also, the number of HCCs was higher in 2020 (p = 0.0503). LRT loco-regional therapies, SD standard deviation, NET neuroendocrine tumour, MWA microwave ablation, N/A not applicable

As noted with prior studies [2] [3] [4] [5] , the LDP induced an overall reduction in the number of elective IR procedures, with a relative increase in emergency procedures. The present study showed that this interruption in IR procedures may have a negative impact for liver oncology patients. Interruption of the elective IR oncological procedures was planned based on the Portuguese declaration of the LDP and local Hospital constraints [1] . Our IR unit is located at a COVID-referral hospital, so all priorities were given to optimize response to COVID patients. However, the 2-week delay in IR response hardly justifies itself the disease progression of liver tumors and the higher MELD scores observed in 2020 when compared to 2019. There was also a prioritization of patients with more advanced liver tumors to be immediately treated after the LDP that may partially justify these differences. Also, delays in diagnostic imaging studies, missed or delayed clinical appointments due to the COVID-19 pandemic are likely to have contributed to these differences but were not quantified with the available data. All efforts should be made to maintain IR oncology service lines during this COVID-19 pandemic to avoid disease progression that may have a negative impact on overall survival for these patients.

Diário da República no. 55/2020, 3°Suplemento, Série I de

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Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations

Table 3 Compared outcomes measures from patients with HCC and liver metastases scheduled for LRT between 2 May and 16

Time from MDTM to LRT (days), mean (SD)

LRT loco-regional therapies, MDTM multidisciplinary team meeting, SD standard deviation J. Veiga et al.: The Covid-19 Pandemic Constraints May Lead to Disease Progression for…

Acknowledgements This data was not presented at any scientific meeting nor is being considered for publication in any other journal.Funding No grants or funding were obtained for this specific manuscript.

Conflict of interest Tiago Bilhim is a paid consultant for Merit Medical and has received speaker fees for Philips Medical, Cook Medical, Terumo and is a stock holder for EmbolX. Nuno Vasco Costa is a paid consultant for Merit Medical. Filipe Veloso Gomes is a paid consultant for Terumo.Ethical Approval Institutional review board approval was waived to perform this retrospective analysis.Informed Consent Written informed consent was obtained from all patients.