Impact of the COVID-19 Pandemic on Liver Cancer Staging at a Multidisciplinary Liver Cancer Clinic

Daniel Li, MD, MA; Angela Y. Jia, MD, PhD; Jane Zorzi, BS; Paige Griffith, MSN, AG-ACNP, BSN; Amy K. Kim, MD; Doan Dao, MD; Robert A. Anders, MD, PhD; Christos Georgiades, MD, PhD; Robert P. Liddell, MD; Kelvin Hong, MD; Nilofer S. Azad, MD; Won Jin Ho, MD; Marina Baretti, MD; Eric Christenson, MD; Azarakhsh Baghdadi, MD, MAS; Ihab R. Kamel, MD, PhD; Jeffrey Meyer, MD; Elie Ghabi, MD; Richard A. Burkhart, MD; Kelly Lafaro, MD, MPH; Jin He, MD; Chris Shubert, MD; Mark Yarchoan, MD

doi:10.1097/AS9.0000000000000207

Annals of Surgery Open (Dec 2022)

Impact of the COVID-19 Pandemic on Liver Cancer Staging at a Multidisciplinary Liver Cancer Clinic

Daniel Li, MD, MA,
Angela Y. Jia, MD, PhD,
Jane Zorzi, BS,
Paige Griffith, MSN, AG-ACNP, BSN,
Amy K. Kim, MD,
Doan Dao, MD,
Robert A. Anders, MD, PhD,
Christos Georgiades, MD, PhD,
Robert P. Liddell, MD,
Kelvin Hong, MD,
Nilofer S. Azad, MD,
Won Jin Ho, MD,
Marina Baretti, MD,
Eric Christenson, MD,
Azarakhsh Baghdadi, MD, MAS,
Ihab R. Kamel, MD, PhD,
Jeffrey Meyer, MD,
Elie Ghabi, MD,
Richard A. Burkhart, MD,
Kelly Lafaro, MD, MPH,
Jin He, MD,
Chris Shubert, MD,
Mark Yarchoan, MD

Affiliations

Daniel Li, MD, MA: From the * Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
Angela Y. Jia, MD, PhD: † Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
Jane Zorzi, BS: From the * Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
Paige Griffith, MSN, AG-ACNP, BSN: From the * Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
Amy K. Kim, MD: ‡ Department of Medicine, Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD
Doan Dao, MD: ‡ Department of Medicine, Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD
Robert A. Anders, MD, PhD: § Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
Christos Georgiades, MD, PhD: ∥ Department of Radiology and Radiological Sciences, Division of Vascular and Interventional Radiology, Johns Hopkins University School of Medicine, Baltimore, MD
Robert P. Liddell, MD: ∥ Department of Radiology and Radiological Sciences, Division of Vascular and Interventional Radiology, Johns Hopkins University School of Medicine, Baltimore, MD
Kelvin Hong, MD: ∥ Department of Radiology and Radiological Sciences, Division of Vascular and Interventional Radiology, Johns Hopkins University School of Medicine, Baltimore, MD
Nilofer S. Azad, MD: From the * Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
Won Jin Ho, MD: From the * Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
Marina Baretti, MD: From the * Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
Eric Christenson, MD: From the * Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
Azarakhsh Baghdadi, MD, MAS: ¶ Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
Ihab R. Kamel, MD, PhD: ¶ Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
Jeffrey Meyer, MD: † Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
Elie Ghabi, MD: # Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Richard A. Burkhart, MD: # Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Kelly Lafaro, MD, MPH: # Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Jin He, MD: # Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Chris Shubert, MD: # Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Mark Yarchoan, MD: From the * Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD

DOI: https://doi.org/10.1097/AS9.0000000000000207
Journal volume & issue: Vol. 3, no. 4
p. e207

Abstract

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Objectives:. To compare liver cancer resectability rates before and during the COVID-19 pandemic. Background:. Liver cancers usually present with nonspecific symptoms or are diagnosed through screening programs for at-risk patients, and early detection can improve patient outcomes. In 2020, the COVID-19 pandemic upended medical care across all specialties, but whether the pandemic was associated with delays in liver cancer diagnosis is not known. Methods:. We performed a retrospective review of all patients evaluated at the Johns Hopkins Multidisciplinary Liver Cancer Clinic from January 2019 to June 2021 with a new diagnosis of suspected or confirmed hepatocellular carcinoma (HCC) or biliary tract cancer (BTC). Results:. There were 456 liver cancer patients (258 HCC and 198 BTC). From January 2019 to March 2020 (pre-pandemic), the surgical resectability rate was 20%. The subsequent 6 months (early pandemic), the resectability rate decreased to 11%. Afterward from October 2020 to June 2021 (late pandemic), the resectability rate increased to 27%. The resectability rate early pandemic was significantly lower than that for pre-pandemic and later pandemic combined (11% lower; 95% confidence interval [CI], 2%–20%). There was no significant difference in resectability rates pre-pandemic and later pandemic (7% difference; 95% CI, –3% to 16%). In subgroup analyses, the early pandemic was associated with a larger impact in BTC resectability rates than HCC resectability rates. Time from BTC symptom onset until Multidisciplinary Liver Clinic evaluation increased by over 6 weeks early pandemic versus pre-pandemic (Hazard Ratio, 0.63; 95% CI, 0.44–0.91). Conclusions:. During the early COVID-19 pandemic, we observed a drop in the percentage of patients presenting with curable liver cancers. This may reflect delays in liver cancer diagnosis and contribute to excess mortality related to the COVID-19 pandemic.

Published in Annals of Surgery Open

ISSN: 2691-3593 (Online)
Publisher: Wolters Kluwer Health
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: https://journals.lww.com/aosopen/pages/default.aspx

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