Increased delays of care during the COVID-19 pandemic: experience of a lung cancer rapid diagnostic center.

[CONTEXT] The COVID-19 pandemic has disrupted hospital organisation and management of chronic pathologies, such as lung cancer. Our objective was to evaluate the impact of COVID-19 on delays in lung cancer care at a French Lung Cancer Rapid Diagnostic Center (RDC).

[METHODS] All patients diagnosed with lung cancer through the RDC at Tenon hospital were included in this retrospective study. The main outcomes were delays (in days) of medical (diagnosis and treatment) care over two periods: period 1 in 2016 (P1, pre-COVID) and period 2 in 2020 (P2, during COVID). Two individualized pathways were considered based on the type of first treatment (surgery or chemo ± immunotherapy).

[RESULTS] A total of 227 and 293 patients were referred to the RDC during periods P1 and P2, respectively. Lung cancer was diagnosed in 118 patients (52 %) in P1 and 145 patients (49.5 %) in P2 (p=0.29). Patient characteristics were comparable between the two periods, except for TNM stage. A higher proportion of patients with localised stage was diagnosed in P2 compared to P1 (42.1 %¦vs 29.7 %; p=0.02). All delays increased significantly during P2, both pre-hospital steps (e.g. the delay in accessing the first consultation at RDC, which increased from 4 to 13 days, p < 0.0001) and in-hospital steps (e.g. the delay from the first consultation at RDC to the first treatment, which rose from 37.5 to 49 days, p < 0.0001). The surgery pathway was the most impacted, with a significant increase in the overall delay (67 days in P1 vs 109 days in P2, p < 0.0001). The only delay that did not increase between P1 and P2 was the delay in accessing molecular biology.

[CONCLUSIONS] Although the RDC remained open, our delays in lung cancer care increased during the COVID-19 pandemic. These increased delays particularly affected the management of localised lung cancers, which are the most curable. Given the shift toward ambulatory care outlined in the new 2021-2030 National Cancer Plan established by french health authorities, regular evaluations of care delays should be conducted, particularly in the context of health crisis.