The United States experience with diagnosing and treating esophageal cancer during the SARS‐CoV‐2 pandemic: A retrospective cohort study

Abstract

AbstractThe downstream effects on healthcare delivery during the initial wave of the COVID‐19 pandemic remain unclear. The purpose of this study was to determine how the healthcare environment surrounding the pandemic affected the oncologic care of patients diagnosed with esophageal cancer. This was a retrospective cohort study evaluating patients in the National Cancer Database (2019–2020). Patients with esophageal cancer diagnoses were divided into pre‐pandemic (2019) and pandemic (2020) groups. Patient demographics, cancer‐related variables, and treatment modalities were compared. Among 26,231 esophageal cancer patients, 14,024 patients (53.5%) were in the pre‐pandemic cohort and 12,207 (46.5%) were in the pandemic cohort. After controlling for demographics, patients diagnosed during the pandemic were more likely to have poorly differentiated tumors (odds ratio [OR] 1.24, 95% confidence interval [CI] 1.08–1.42), pathologic T3 disease compared to T1 (OR 1.25, 95% CI 1.02–1.53), positive lymph nodes on pathology (OR 1.36, 95% CI 1.14–1.64), and to be pathologic stage IV (OR 1.51, 95% CI 1.29–1.76). After controlling for oncologic characteristics, patients diagnosed during the pandemic were more likely to require at least two courses of systemic therapy (OR 1.78, 95% CI 1.48–2.14) and to be offered palliative care (OR 1.13, 95% CI 1.04–1.22). While these patients were offered curative therapy at lower rates, this became non‐significant after risk‐adjustment (p = .15). The pandemic healthcare environment was associated with significantly increased risk‐adjusted rates of patients presenting with advanced esophageal cancer. While this led to significant differences in treatment, most of these differences became non‐significant after controlling for oncologic factors.