Delays in Cancer Diagnostic Testing at a Quick Referral Unit in Spain during COVID-19
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Setting
2.2. Study Population
2.3. Data Collection and Measurements
2.4. Statistical Analysis
3. Results
3.1. Study Population
3.2. Referral Volumes
3.3. Characteristics of Study Population
3.4. Appointments and Procedure Volumes
3.5. Waiting Times
3.6. Cancer Diagnosis
4. Discussion
4.1. Limitations
4.2. Implications
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Elliss-Brookes, L.; McPhail, S.; Ives, A.R.; Greenslade, M.; Shelton, J.G.; Hiom, S.; Richards, M.G. Routes to diagnosis for cancer—Determining the patient journey using multiple routine data sets. Br. J. Cancer 2012, 107, 1220–1226. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Rubin, G.; Berendsen, A.; Crawford, S.M.; Dommett, R.; Earle, C.; Emery, J.; Fahey, T.; Grassi, L.; Grunfeld, E.; Gupta, S.; et al. The expanding role of primary care in cancer control. Lancet Oncol. 2015, 16, 1231–1272. [Google Scholar] [CrossRef] [Green Version]
- Bosch, X.; Aibar, J.; Capell, S.; Coca, A.; López-Soto, A. Quick diagnosis units: A potentially useful alternative to conventional hospitalisation. Med. J. Aust. 2009, 191, 496–498. [Google Scholar] [CrossRef]
- NHS England. Rapid Diagnostic Centres Vision and 2019/20 Implementation Specification. Available online: https://www.england.nhs.uk/publication/rapid-diagnostic-centres-vision-and-2019-20-implementation-specification/ (accessed on 8 September 2021).
- Forster, A.S.; Renzi, C.; Lyratzopoulos, G. Diagnosing cancer in patients with ‘non-alarm’ symptoms: Learning from diagnostic care innovations in Denmark. Cancer Epidemiol. 2018, 54, 101–103. [Google Scholar] [CrossRef] [PubMed]
- Corbella, X.; Barreto, J.V.; Bassetti, S.; Bivol, M.; Castellino, P.; de Kruijf, E.-J.; Dentali, F.; Durusu-Tanriöver, M.; Fierbinţeanu-Braticevici, C.; Hanslik, T.; et al. Hospital ambulatory medicine: A leading strategy for Internal Medicine in Europe. Eur. J. Intern. Med. 2018, 54, 17–20. [Google Scholar] [CrossRef] [PubMed]
- Conley, J.; O’Brien, C.W.; Leff, B.A.; Bolen, S.; Zulman, D. Alternative strategies to inpatient hospitalization for acute medical conditions: A systematic review. JAMA Intern. Med. 2016, 176, 1693–1702. [Google Scholar] [CrossRef]
- Bosch, X.; Escoda, O.; Nicolás, D.; Coloma, E.; Fernández, S.; Coca, A.; López-Soto, A. Primary care referrals of patients with potentially serious diseases to the emergency department or a quick diagnosis unit: A cross-sectional retrospective study. BMC Fam. Pract. 2014, 15, 75. [Google Scholar] [CrossRef] [PubMed]
- Bosch, X.; Jordán, A.; López-Soto, A. Quick diagnosis units: Avoiding referrals from primary care to the ED and hospitalizations. Am. J. Emerg. Med. 2013, 31, 114–123. [Google Scholar] [CrossRef]
- Chapman, D.; Poirier, V.; Vulkan, D.; Fitzgerald, K.; Rubin, G.; Hamilton, W.; Duffy, S.W.; Thomas, A.H.; Gulliford, D.; Rolfe, H.; et al. First results from five multidisciplinary diagnostic centre (MDC) projects for non-specific but concerning symptoms, possibly indicative of cancer. Br. J. Cancer 2020, 123, 722–729. [Google Scholar] [CrossRef]
- Stenman, E.; Palmér, K.; Rydén, S.; Sävblom, C.; Svensson, I.; Rose, C.; Ji, J.; Nilbert, M.; Sundquist, J. Diagnostic spectrum and time intervals in Sweden’s first diagnostic center for patients with nonspecific symptoms of cancer. Acta Oncol. 2019, 58, 296–305. [Google Scholar] [CrossRef] [Green Version]
- Richards, M.; Anderson, M.; Carter, P.; Ebert, B.L.; Mossialos, E. The impact of the COVID-19 pandemic on cancer care. Nat. Cancer 2020, 1, 565–567. [Google Scholar] [CrossRef] [PubMed]
- Hanna, T.P.; King, W.D.; Thibodeau, S.; Jalink, M.; Paulin, G.; Harvey-Jones, E.; O’Sullivan, D.; Booth, C.M.; Sullivan, R.; Aggarwal, A. Mortality due to cancer treatment delay: Systematic review and meta-analysis. BMJ (Clin. Res. Ed.) 2020, 371, m4087. [Google Scholar] [CrossRef] [PubMed]
- Maringe, C.; Spicer, J.; Morris, M.; Purushotham, A.; Nolte, E.; Sullivan, R.; Rachet, B.; Aggarwal, A. The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: A national, population-based, modelling study. Lancet Oncol. 2020, 21, 1023–1034. [Google Scholar] [CrossRef]
- Coma, E.; Guiriguet, C.; Mora, N.; Marzo-Castillejo, M.; Benítez, M.; Méndez-Boo, L.; Fina, F.; Fàbregas, M.; Mercadé, A.; Medina, M. Impact of the COVID-19 pandemic and related control measures on cancer diagnosis in Catalonia: A time-series analysis of primary care electronic health records covering about five million people. BMJ Open 2021, 11, e047567. [Google Scholar] [CrossRef]
- Ministerio de Sanidad. Enfermedad por el Coronavirus (COVID-19). Actualización No 282: 31 December 2020. Available online: https://www.mscbs.gob.es/profesionales/saludPublica/ccayes/alertasActual/nCov/documentos/Actualizacion_282_COVID-19.pdf (accessed on 8 September 2021).
- Pérez Sust, P.; Solans, O.; Fajardo, J.C.; Medina Peralta, M.; Rodenas, P.; Gabaldà, J.; Eroles, L.G.; Cornella, A.; Munoz, C.V.; Ribes, J.S.; et al. Turning the crisis into an opportunity: Digital health strategies deployed during the COVID-19 outbreak. JMIR Public Health Surveill. 2020, 6, e19106. [Google Scholar] [CrossRef] [PubMed]
- Bosch, X.; Capdevila, A.; Grafia, I.; Ladino, A.; Moreno, P.J.; López-Soto, A. The impact of Covid-19 on patients with suspected cancer: An analysis of ED presentation and referrals to a quick diagnosis unit. Am. J. Emerg. Med. 2021, 48, 1–11. [Google Scholar] [CrossRef]
- Bosch, X.; Ladino, A.; Moreno-Lozano, P.; Jordán, A.; López-Soto, A. Trends in hospitalization of patients with potentially serious diseases evaluated at a quick diagnosis clinic. Diagnostics 2020, 10, 585. [Google Scholar] [CrossRef]
- Charlson, M.E.; Pompei, P.; Ales, K.L.; MacKenzie, C.R. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J. Chronic Dis. 1987, 40, 373–383. [Google Scholar] [CrossRef]
- Oken, M.M.; Creech, R.H.; Tormey, D.C.; Horton, J.; Davis, T.; McFadden, E.T.; Carbone, P.P. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am. J. Clin. Oncol. 1982, 5, 649–655. [Google Scholar] [CrossRef]
- Fritz, A.; Percy, C.; Jack, A.; Shanmugaratnam, K.; Sobin, L.H.; Parkin, M.D. (Eds.) International Classification of Diseases for Oncology (ICD-O-3), 3rd ed.; World Health Organization: Geneva, Switzerland, 2000. [Google Scholar]
- Brierley, J.D.; Gospodarowicz, M.K.; Wittekind, C. (Eds.) TNM Classification of Malignant Tumours, 8th ed.; John Wiley & Sons: Oxford, UK, 2017. [Google Scholar]
- Ministerio de la Presidencia. Real Decreto 463/2020, de 14 de Marzo, por el que se Declara el Estado de Alarma Para la Gestión de la Situación de Crisis Sanitaria Ocasionada por el COVID-19 (BOE-A-2020-3692) (14 March 2020). Available online: https://www.boe.es/buscar/doc.php?id=BOE-A-2020-3692 (accessed on 11 November 2021).
- Ministerio de la Presidencia. Real Decreto 926/2020, de 25 de Octubre, por el que se Declara el Estado de Alarma Para Contener la Propagación de Infecciones Causadas por el SARS-CoV-2 (BOE-A-2020-12898) (25 October 2020). Available online: https://www.boe.es/buscar/doc.php?id=BOE-A-2020-12898 (accessed on 11 November 2021).
- Greenwood, E.; Swanton, C. Consequences of COVID-19 for cancer care—A CRUK perspective. Nat. Rev. Clin. Oncol. 2021, 18, 3–4. [Google Scholar] [CrossRef]
- Morris, E.J.; Goldacre, R.; Spata, E.; Mafham, M.; Finan, P.J.; Shelton, J.; Richards, M.; Spencer, K.; Emberson, J.; Hollings, S.; et al. Impact of the COVID-19 pandemic on the detection and management of colorectal cancer in England: A population-based study. Lancet Gastroenterol. Hepatol. 2021, 6, 199–208. [Google Scholar] [CrossRef]
- Petrova, D.; Pollán, M.; Rodriguez-Barranco, M.; Garrido, D.; Borrás, J.M.; Sánchez, M.J. Anticipated help-seeking for cancer symptoms before and after the coronavirus pandemic: Results from the Onco-barometer population survey in Spain. Br. J. Cancer 2021, 124, 2017–2025. [Google Scholar] [CrossRef] [PubMed]
- Naidich, J.J.; Boltyenkov, A.; Wang, J.J.; Chusid, J.; Hughes, D.; Sanelli, P.C. Impact of the coronavirus disease 2019 (COVID-19) pandemic on imaging case volumes. J. Am. Coll. Radiol. 2020, 17, 865–872. [Google Scholar] [CrossRef]
- Freudenberg, L.S.; Paez, D.; Giammarile, F.; Cerci, J.; Modiselle, M.; Pascual, T.N.; El-Haj, N.; Orellana, P.; Pynda, Y.; Carrió, I.; et al. Global impact of COVID-19 on nuclear medicine departments: An international survey in April 2020. J. Nucl. Med. 2020, 61, 1278–1283. [Google Scholar] [CrossRef] [PubMed]
- Rutter, M.D.; Brookes, M.; Lee, T.J.; Rogers, P.; Sharp, L. Impact of the COVID-19 pandemic on UK endoscopic activity and cancer detection: A national endoscopy database analysis. Gut 2021, 70, 537–543. [Google Scholar] [CrossRef] [PubMed]
- Khan, A.; Bilal, M.; Morrow, V.; Cooper, G.; Thakkar, S.; Singh, S. Impact of the coronavirus disease 2019 pandemic on gastrointestinal procedures and cancers in the United States: A multicenter research network study. Gastroenterology 2021, 160, 2602–2604. [Google Scholar] [CrossRef]
- Kaufman, H.W.; Chen, Z.; Niles, J.; Fesko, Y. Changes in the number of US patients with newly identified cancer before and during the coronavirus disease 2019 (COVID-19) pandemic. JAMA Netw. Open 2020, 3, e2017267. [Google Scholar] [CrossRef]
- Kempf, E.; Lamé, G.; Layese, R.; Priou, S.; Chatellier, G.; Chaieb, H.; Benderra, M.-A.; Bellamine, A.; Bey, R.; Bréant, S.; et al. New cancer cases at the time of SARS-Cov2 pandemic and related public health policies: A persistent and concerning decrease long after the end of the national lockdown. Eur. J. Cancer 2021, 150, 260–267. [Google Scholar] [CrossRef]
- NHS England. Second Phase of NHS Response to COVID-19 for Cancer Services. Available online: https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/06/C0511-second-phase-of-nhs-response-to-COVID-19-for-cancer-services-letter.pdf (accessed on 8 September 2021).
2019: 26 February–30 April | COVID-Impacted Period (2020: 26 February–28 April) | p-Value | |
---|---|---|---|
Referrals | |||
Total, n | 201 | 126 | |
Age, years, mean ± SD | 68.22 ± 14.91 | 66.35 ± 13.73 | 0.1134 |
<65 | 70 (34.83) | 47 (37.30) | |
≥65 | 131 (65.17) | 79 (62.70) | |
Sex, n (%) | 0.1324 | ||
Male | 108 (53.73) | 65 (51.59) | |
Female | 93 (46.27) | 61 (48.41) | |
Household income per capita, €, n (%) 1 | 0.1380 | ||
<18,000 | 105 (52.24) | 63 (50.00) | |
18,000–100,000 | 82 (40.80) | 54 (42.86) | |
>100,000 | 14 (6.97) | 9 (7.14) | |
Comorbidity index, n (%) | 0.0556 | ||
0–1 | 141 (70.15) | 94 (74.60) | |
2 | 44 (21.89) | 27 (21.43) | |
≥3 | 16 (7.96) | 5 (3.97) | |
Smoking status, n (%) | 0.1433 | ||
Current | 64 (31.84) | 37 (29.37) | |
Former | 48 (23.88) | 30 (23.81) | |
None | 89 (44.28) | 59 (46.83) | |
Alcohol intake, n (%) | 0.0786 | ||
Excessive | 23 (11.44) | 12 (9.52) | |
Normal limits | 49 (24.38) | 26 (20.64) | |
None | 129 (64.18) | 88 (69.84) | |
Presenting manifestations, n (%) | |||
Unexplained weight loss/fatigue | 31 (15.42) | 22 (17.46) | |
Fever of unknown origin/sweats | 13 (6.48) | 10 (7.94) | |
Nonspecific gastrointestinal symptoms and signs | 11 (5.47) | 9 (7.14) | |
Unexplained progressive pain (non-abdominal) | 9 (4.48) | 5 (3.97) | |
Abdominal pain | 14 (6.97) | 10 (7.94) | |
Effusions (ascites, pleural, pericardial) | 9 (4.48) | 4 (3.17) | |
Jaundice/cholestasis | 10 (4.98) | 8 (6.35) | |
Anemia | 32 (15.92) | 18 (14.29) | |
Persistently abnormal laboratory tests | 10 (4.98) | 7 (5.56) | |
Mass (abdominal/liver, lung/mediastinal, bone, brain) | 14 (6.97) | 10 (7.94) | |
Lung consolidation/opacity | 6 (2.99) | 3 (2.38) | |
Abnormal lymphadenopathy/lumps | 16 (7.96) | 8 (6.35) | |
Overt blood loss (hematuria, hematochezia, hemoptysis, vaginal bleeding) | 17 (8.46) | 9 (7.14) | |
Dyspnea/persistent cough | 4 (1.99) | 1 (0.79) | |
Dysphagia | 5 (2.49) | 2 (1.59) | |
Diagnosis, n (%) | |||
Benign organic diseases | 137 (68.16) | 84 (66.67) | |
Cancer | 43 (21.39) | 20 (15.87) | |
Other | 21 (10.45) | 22 (17.46) | |
Cancer: nature of presenting symptoms, n (%) | 0.1295 | ||
Focal | 29 (67.44) | 13 (65.00) | |
Nonspecific | 14 (32.56) | 7 (35.00) | |
Cancer: pre-referral consultations, n (%) | 0.0092 | ||
1 | 22 (51.16) | 9 (45.00) | |
2 | 11 (25.58) | 9 (45.00) | |
≥3 | 10 (23.26) | 2 (10.00) | |
Cancer: performance score, n (%) | 0.0337 | ||
0–1 | 20 (46.51) | 11 (55.00) | |
2 | 15 (34.88) | 6 (30.00) | |
3–4 | 8 (18.60) | 3 (15.00) | |
Nonmalignant organic diseases, n (%) | |||
Hematological | 4 (2.92) | 1 (1.19) | |
Gastrointestinal diseases | 33 (24.09) | 19 (22.62) | |
Genitourinary | 6 (4.38) | 3 (3.57) | |
Respiratory | 4 (2.92) | 4 (4.76) | |
Infections (viral) | 7 (5.11) | 5 (5.95) | |
Gynecological | 6 (4.38) | 2 (2.38) | |
Bone | 7 (5.11) | 4 (4.76) | |
Hepatobiliary/pancreatic diseases | 15 (10.95) | 10 (11.90) | |
Benign neoplasms/reactive lymphadenitis | 6 (4.38) | 4 (4.76) | |
Rheumatic/autoimmune/granulomatous diseases | 9 (6.57) | 5 (5.95) | |
Endocrine diseases | 7 (5.11) | 4 (4.76) | |
Other | 33 (24.09) | 23 (27.38) |
Period (2020) | |||||
---|---|---|---|---|---|
Pre-COVID | COVID-Impacted | De-Escalation | Second Wave | 26 February–30 December | |
1 January–25 February | 26 February–28 April | 29 April–30 June | 1 July–30 December | ||
Referrals | |||||
Total, n | 176 | 126 | 169 | 504 | 799 |
Mean (weekly) ± SD | 22.00 ± 3.38 | 14.00 ± 3.46 | 18.78 ± 2.11 | 19.38 ± 2.08 | 18.16 ± 3.19 |
p-value | 0.6301 | <0.0001 | 0.0149 | 0.0009 | <0.0001 |
Appointments per case, mean ± SD | 3.13 ± 0.35 | 2.89 ± 0.60 | 3.00 ± 0.50 | 3.23 ± 0.43 | 3.11 ± 0.49 |
p-value | >0.9999 | 0.4442 | 0.6755 | 0.5380 | 0.8321 |
Ratio of successive/first visits, mean ± SD | 1.98 ± 0.23 | 1.77 ± 0.54 | 1.90 ± 0.48 | 2.08 ± 0.37 | 1.98 ± 0.44 |
Ratio of telehealth/total visits, % | 0.37 | 58.51 | 30.27 | 17.67 | 33.56 |
Diagnostic procedure | |||||
GI endoscopy/USE | |||||
Number per period (vs. 2019) | 68 (vs. 69) | 43 (vs. 76) | 58 (vs. 77) | 184 (vs. 227) | 285 (vs. 380) |
Mean ± SD | 8.50 ± 1.41 | 4.78 ± 2.17 | 6.44 ± 1.74 | 7.08 ± 1.81 | 6.48 ± 2.04 |
Percent reduction (95% CI) | −3.17 (−21.97–15.62) | 42.04 (22.66–61.42) | 24.18 (14.26–34.09) | 14.24 (5.73–22.75) | 21.96 (14.97–28.95) |
p-value | 0.9022 | 0.0058 | 0.0324 | 0.0187 | <0.0001 |
CT scan | |||||
Number per period (vs. 2019) | 57 (vs. 59) | 34 (vs. 63) | 50 (vs. 64) | 152 (vs. 179) | 236 (vs. 306) |
Mean ± SD | 7.13 ± 1.55 | 3.78 ± 1.20 | 5.56 ± 1.13 | 5.85 ± 1.41 | 5.36 ± 1.53 |
Percent reduction (95% CI) | 1.19 (−14.96–17.34) | 39.42 (17.75–61.08) | 19.66 (7.58–31.73) | 10.53 (2.65–18.41) | 18.30 (11.20–25.40) |
p-value | 0.7682 | 0.0009 | 0.0509 | 0.0502 | 0.0001 |
PET/CT scan | |||||
Number per period (vs. 2019) | 24 (vs. 26) | 16 (vs. 27) | 23 (vs. 30) | 69 (vs. 82) | 108 (vs. 139) |
Mean ± SD | 3.00 ± 1.51 | 1.78 ± 1.09 | 2.56 ± 1.13 | 2.65 ± 1.33 | 2.46 ± 1.27 |
Percent reduction (95% CI) | −4.79 (−57.46–47.88) | 34.45 (6.70–62.19) | 15.56 (−13.77–44.88) | 9.36 (−4.32–23.04) | 15.76 (4.89–26.63) |
p-value | 0.7166 | 0.0746 | 0.2474 | 0.2111 | 0.0199 |
Ultrasonography | |||||
Number per period (vs. 2019) | 45 (vs. 47) | 32 (vs. 50) | 40 (vs. 52) | 122 (vs. 142) | 194 (vs. 244) |
Mean ± SD | 5.63 ± 2.39 | 3.56 ± 2.19 | 4.44 ± 1.51 | 4.69 ± 1.69 | 4.41 ± 1.78 |
Percent reduction (95% CI) | 5.00 (−7.99–17.99) | 38.37 (17.36–59.39) | 22.72 (6.00–39.45) | 13.60 (3.23–23.96) | 20.53 (12.45–28.61) |
p-value | 0.8381 | 0.0412 | 0.0694 | 0.1132 | 0.0024 |
Invasive procedures | |||||
Number per period (vs. 2019) | 19 (vs. 20) | 11 (vs. 22) | 13 (vs. 21) | 46 (vs. 60) | 70 (vs. 103) |
Mean ± SD | 2.38 ± 1.19 | 1.22 ± 0.97 | 1.44 ± 0.53 | 1.77 ± 0.95 | 1.59 ± 0.90 |
Percent reduction (95% CI) | 2.50 (−25.00–30.00) | 47.22 (17.87–76.58) | 29.63 (6.73–52.53) | 17.37 (5.87–28.87) | 25.99 (16.13–35.84) |
p-value | 0.8368 | 0.0189 | 0.0314 | 0.0729 | 0.0006 |
Biopsy/cytology procedures | |||||
(ambulatory) | |||||
Number per period (vs. 2019) | 21 (vs. 23) | 13 (vs. 25) | 19 (vs. 26) | 59 (vs. 72) | 91 (vs. 123) |
Mean ± SD | 2.63 ± 1.06 | 1.44 ± 0.88 | 2.11 ± 0.60 | 2.27 ± 1.00 | 2.07 ± 0.95 |
Percent reduction (95% CI) | 5.21(−19.75–30.17) | 40.37 (12.00–68.74) | 25.00 (8.05–41.95) | 15.38 (1.70–29.07) | 22.46 (12.33–32.59) |
p-value | 0.6337 | 0.0116 | 0.0144 | 0.0596 | 0.0003 |
Period (2020) | Waiting Times (Days, Mean ± SD) | Percent Increase (95% CI) | p-Value |
---|---|---|---|
Appointments | |||
Pre-COVID (1 January–25 February) | 2.59 ± 0.21 | −1.78 (−11.73–8.17) | 0.5911 |
COVID-impacted (26 February–28 April) | 5.61 ± 0.61 | 106.80 (87.46–126.20) | <0.0001 |
De-escalation (29 April–30 June) | 4.59 ± 0.24 | 75.41 (59.54–91.29) | <0.0001 |
Second wave (July 1–30 December) | 3.80 ± 0.38 | 48.14 (39.83–56.45) | <0.0001 |
26 February–30 December | 4.33 ± 0.83 | 65.72 (56.09–75.36) | <0.0001 |
GI endoscopy/USE | |||
Pre-COVID (1 January–25 February) | 5.45 ± 0.44 | −0.54 (−7.84–6.76) | 0.8305 |
COVID-impacted (26 February–28 April) | 14.32 ± 3.24 | 161.50 (111.60–211.40) | <0.0001 |
De-escalation (29 April–30 June) | 10.45 ± 0.84 | 85.58 (66.33–104.80) | <0.0001 |
Second wave (1 July–30 December) | 8.67 ± 0.69 | 58.11 (51.74–64.49) | <0.0001 |
26 February–30 December | 10.19 ± 2.71 | 84.88 (69.06–100.70) | <0.0001 |
CT scan | |||
Pre-COVID (1 January–25 February) | 4.22 ± 0.29 | −0.09 (−8.18–8.01) | 0.8880 |
COVID-impacted (26 February–28 April) | 11.46 ± 2.62 | 171.20 (118.20–224.10) | <0.0001 |
De-escalation (29 April–30 June) | 8.11 ± 0.96 | 90.61 (69.35–111.90) | <0.0001 |
Second wave (1 July–30 December) | 6.87 ± 0.59 | 62.33 (54.73–69.93) | <0.0001 |
26 February–30 December | 8.06 ± 2.22 | 90.37 (73.52–107.20) | <0.0001 |
PET/CT scan | |||
Pre-COVID (1 January–25 February) | 4.17 ± 0.54 | 0.74 (−11.88–13.35) | 0.9880 |
COVID-impacted (26 February–28 April) | 10.36 ± 2.28 | 152.50 (98.21–206.90) | <0.0001 |
De-escalation (29 April–30 June) | 7.26 ± 1.31 | 74.60 (47.82–101.40) | <0.0001 |
Second wave (1 July–30 December) | 6.47 ± 0.60 | 55.84 (48.52–63.16) | <0.0001 |
26 February–30 December | 7.43 ± 1.96 | 79.45 (63.35–95.56) | <0.0001 |
Ultrasonography | |||
Pre-COVID (1 January–25 February) | 3.35 ± 0.37 | −1.44 (−10.11–7.22) | 0.7302 |
COVID-impacted (26 February–28 April) | 8.39 ± 2.39 | 148.40 (89.28–207.50) | <0.0001 |
De-escalation (29 April–30 June) | 6.20 ± 0.61 | 85.69 (65.26–106.10) | <0.0001 |
Second wave (1 July–30 December) | 5.35 ± 0.51 | 58.95 (49.97–67.93) | <0.0001 |
26 February–30 December | 6.15 ± 1.65 | 82.72 (66.73–98.71) | <0.0001 |
Invasive procedures | |||
Pre-COVID (1 January–25 February) | 5.16 ± 0.47 | −0.70 (−8.78–7.38) | 0.8175 |
COVID-impacted (26 February–28 April) | 15.53 ± 3.81 | 200.70 (144.20–257.20) | <0.0001 |
De-escalation (29 April–30 June) | 11.48 ± 1.29 | 122.90 (95.82–150.00) | <0.0001 |
Second wave (1 July–30 December) | 8.80 ± 0.64 | 70.64 (65.46–75.82) | <0.0001 |
26 February–30 December | 10.73 ± 3.23 | 107.90 (88.66–127.20) | <0.0001 |
Biopsy/cytology procedures | |||
Pre-COVID (1 January–25 February) | 3.82 ± 0.36 | −0.91 (−6.77–4.94) | 0.8230 |
COVID-impacted (26 February–28 April) | 8.16 ± 2.22 | 111.20 (71.97–150.40) | <0.0001 |
De-escalation (29 April–30 June) | 6.63 ± 0.52 | 73.19 (64.29–82.09) | <0.0001 |
Second wave (1 July–30 December) | 5.84 ± 0.36 | 52.68 (47.17–58.19) | <0.0001 |
26 February–30 December | 6.48 ± 1.37 | 68.85 (58.51–79.18) | <0.0001 |
Time-to-diagnosis | |||
Pre-COVID (1 January–25 February) | 10.38 ± 0.59 | 0.84 (−8.22–9.89) | 0.9258 |
COVID-impacted (26 February–28 April) | 20.14 ± 3.72 | 97.04 (65.15–128.90) | <0.0001 |
De-escalation (29 April–30 June) | 15.54 ± 0.90 | 51.17 (41.99–60.35) | <0.0001 |
Second wave (1 July–30 December) | 13.64 ± 0.86 | 32.87 (28.47–37.27) | <0.0001 |
26 February–30 December | 15.36 ± 3.12 | 49.74 (39.85–59.62) | <0.0001 |
Period (2020) | |||||
---|---|---|---|---|---|
Pre-COVID | COVID-Impacted | De-Escalation | Second Wave | 26 February–30 December | |
Total, n (%) | 38/176 (21.59) | 20/126 (15.87) | 29/169 (17.16) | 93/504 (18.45) | 142/799 (17.77) |
Mean (weekly) ± SD | 4.75 ± 1.28 | 2.22 ± 1.48 | 3.22 ± 1.72 | 3.58 ± 1.30 | 3.23 ± 1.49 |
Percent reduction (95% CI) | −2.59 (−24.09–18.92) | 54.07 (32.45–75.70) | 30.03 (−1.89–61.94) | 17.55 (2.63–32.47) | 27.57 (15.91–39.23) |
p-value | 0.8631 | 0.0005 | 0.0439 | 0.0028 | <0.0001 |
Primary site/stage III-IV, n (%)/(%) | |||||
Pancreatic | 7 (18.42)/5 (71.43) | 4 (20.00)/3 (75.00) | 6 (20.70)/4 (66.67) | 15 (16.13)/12 (80.00) | 25 (17.61)/19 (76.00) |
Colorectal | 6 (15.79)/3 (50.00) | 3 (15.00)/1 (33.33) | 5 (17.24)/2 (40.00) | 18 (19.35)/10 (55.56) | 26 (18.31)/13 (50.00) |
Hematological | 6 (15.79)/(n.a.) | 3 (15.00)/(n.a.) | 4 (13.79)/(n.a.) | 15 (16.13)/(n.a.) | 22 (15.49)/(n.a.) |
Lung | 5 (13.16)/3 (60.00) | 2 (10.00)/1 (50.00) | 4 (13.79)/3 (75.00) | 13 (13.98)/11 (84.62) | 19 (13.38)/15 (78.95) |
Upper gastrointestinal tract | 3 (7.89)/2 (66.67) | 1 (5.00)/1 (100.00) | 2 (6.90)/1 (50.00) | 6 (6.45)/6 (100.00) | 9 (6.34)/8 (88.89) |
Renal and bladder | 2 (5.26)/1 (50.00) | 1 (5.00)/0 (0.00) | 2 (6.90)/1 (50.00) | 4 (4.30)/1 (25.00) | 7 (4.93)/2 (28.57) |
Hepatobiliary | 2 (5.26)/2 (100.00) | 1 (5.00)/1 (100.00) | 1 (3.45)/1 (100.00) | 4 (4.30)/3 (75.00) | 6 (4.23)5 (83.33) |
Breast | 2 (5.26)/1 (50.00) | 2 (10.00)/2 (100.00) | 2 (6.90)/2 (100.00) | 7 (7.53)/5 (71.43) | 11 (7.75)/9 (81.82) |
Prostate | 2 (5.26)/2 (100.00) | 1 (5.00)/1 (100.00) | 1 (3.45)/1 (100.00) | 3 (3.23)/2 (66.67) | 5 (3.52)/4 (80.00) |
Gynecological 1 | 1 (2.63)/0 (0.00) | 1 (5.00)/1 (100.00) | 1 (3.45)/1 (100.00) | 4 (4.30)/3 (75.00) | 6 (4.23)/5 (83.33) |
Cancer of unknown primary site | 1 (2.63)/1 (100.00) | 0 (0.00)/(n.a.) | 0 (0.00)/(n.a.) | 1 (1.08)/1 (100.00) | 1 (0.70)/1 (100.00) |
Sarcoma | 1 (2.63)/1 (100.00) | 0 (0.00)/(n.a.) | 0 (0.00)/(n.a.) | 2 (2.15)/1 (50.00) | 2 (1.41)/1 (50.00) |
Neuroendocrine tumor | 0 (0.00)/(n.a.) | 0 (0.00)/(n.a.) | 1 (3.45)/1 (100.00) | 0 (0.00)/(n.a.) | 1 (0.70)/1 (100.00) |
Malignant melanoma | 0 (0.00)/(n.a.) | 1 (5.00)/1 (100.00) | 0 (0.00)/(n.a.) | 0 (0.00)/(n.a.) | 1 (0.70)/1 (100.00) |
Mesothelioma | 0 (0.00)/(n.a.) | 0 (0.00)/(n.a.) | 0 (0.00)/(n.a.) | 1 (1.08)/1 (100.00) | 1 (0.70)1 (100.00) |
Stage III-IV 2, total n (%) | 21/32 (65.63) | 12/17 (70.59) | 17/25 (68.00) | 56/78 (71.79) | 85/120 (70.83) |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Bosch, X.; Torres, M.; Moreno, P.; López-Soto, A. Delays in Cancer Diagnostic Testing at a Quick Referral Unit in Spain during COVID-19. Diagnostics 2021, 11, 2096. https://doi.org/10.3390/diagnostics11112096
Bosch X, Torres M, Moreno P, López-Soto A. Delays in Cancer Diagnostic Testing at a Quick Referral Unit in Spain during COVID-19. Diagnostics. 2021; 11(11):2096. https://doi.org/10.3390/diagnostics11112096
Chicago/Turabian StyleBosch, Xavier, Manuel Torres, Pedro Moreno, and Alfonso López-Soto. 2021. "Delays in Cancer Diagnostic Testing at a Quick Referral Unit in Spain during COVID-19" Diagnostics 11, no. 11: 2096. https://doi.org/10.3390/diagnostics11112096