Impact of the COVID-19 Pandemic on Delay in Treatment Initiation for Oral Cavity and Oropharyngeal Cancer in Brazil

Israel Monteiro Araújo; Márcio Vinícius Campos Borges; Luís Gustavo Souza Santos; Jessilene Ribeiro Rocha; Érika Martins Pereira; Vandilson Pinheiro Rodrigues

Authors

Israel Monteiro Araújo
Márcio Vinícius Campos Borges
Luís Gustavo Souza Santos
Jessilene Ribeiro Rocha
Érika Martins Pereira
Vandilson Pinheiro Rodrigues

Keywords:

Mouth Neoplasms, Oropharyngeal Neoplasms, COVID-19, Time-to-Treatment

Abstract

Objective: To analyze the impact of the COVID-19 pandemic on the interval between diagnosis and initiation of treatment for oral cavity and oropharyngeal cancer in Brazil. Material and Methods: A time series study was conducted using secondary data extracted from the DATASUS system. The three-year period from 2019 to 2021 was selected to represent the baseline, onset, and peak of reported COVID-19 cases. The dependent variable of the study was the delay in starting anticancer treatment (>60 days after histopathologic diagnosis). Time series were analyzed using joint-point regression and monthly percentage changes (MPC) were estimated. Results: For oral cavity cancer, there were two periods of decrease in the delay in treatment initiation, from January 2019 to June 2020 (MPC= -0.75, 95% CI = -0.3 to -3.2, p=0.004) and from November 2020 to December 2021 (MPC= -1.41, 95% CI = -2.2 to -0.6, p=0.001). For oropharyngeal cancer, there was an increase in the percentage of delays in treatment initiation from January 2019 to February 2020 (MPC= 0.86, 95% CI = 0.2 to 1.5, p=0.014) and from May 2020 to December 2020 (MPC= 3.66, 95% CI = 1.2 to 6.2, p=0.005), with a decrease from December 2020 to December 2021 (MPC= -1.40, 95% CI = -2.3 to -0.5, p=0.003). Conclusion: The COVID-19 pandemic in Brazil had a greater impact on treatment initiation delay for oropharyngeal cancer than for oral cavity cancer. However, the percentage of delay in treatment initiation for oropharyngeal cancer showed fluctuation, with an increase in the pre-pandemic period and a decrease after December 2020.

References

Santos MO, Lima FCDS, Martins LFL, Oliveira JFP, Almeida LM, Cancela MC. Estimated cancer incidence in Brazil, 2023-2025. Rev Bras Cancerol 2023; 69(1):e-213700. https://doi.org/10.32635/2176-9745.RBC.2023v69n1.3700

Brasil. Lei nº 12.732, de 22 de novembro de 2012. Dispõe sobre o primeiro tratamento de paciente com neoplasia maligna comprovada e estabelece prazo para seu início. Diário Oficial da União. 2012. Available from: https://www.planalto.gov.br/ccivil_03/_ato2011-2014/2012/lei/l12732.htm [Accessed on August 15, 2023]. [In Portuguese].

Brasil. Ministério da Saúde. Tabnet Datasus Painel Oncologia. Available from: https://datasus.saude.gov.br/ [Accessed on September 6, 2023]. [In Portuguese].

França MADSA, Nery NG, Antunes JLF, Freire MDCM. Timeframe for initiating oral cancer treatment in Brazil since approval of new legislation in 2012: time trend, 2013-2019. Cad Saude Publ 2021; 37:e00293220. https://doi.org/10.1590/0102-311X00293220

Aquino EM, Silveira IH, Pescarini JM, Aquino R, Souza-Filho JAD. Social distancing measures to control the COVID-19 pandemic: potential impacts and challenges in Brazil. Cienc Saude Col 2020; 25(S1):2423-2446. https://doi.org/10.1590/1413-81232020256.1.10502020

Brasil. Lei nº 13.979, de 6 de fevereiro de 2020. Dispõe sobre as medidas para enfrentamento da emergência de saúde pública de importância internacional decorrente do coronavírus responsável pelo surto de 2019. Diário Oficial da União. 2020. Available from: https://www.planalto.gov.br/ccivil_03/_ato2019-2022/2020/lei/l13979.htm [Accessed on August 15, 2023]. [In Portuguese].

Atty ATM, Tomazelli J, Dias MBK, Ribeiro CM. Impact of the COVID-19 Pandemic on the diagnosis of oral cancer in Brazil. Rev Bras Cancerol 2022; 68(4):e-042675. https://doi.org/10.32635/2176-9745.RBC.2022v68n4.2675

Riera R, Bagattini ÂM, Pacheco RL, Pachito DV, Roitberg F, Ilbawi A. Delays and disruptions in cancer health care due to COVID-19 pandemic: Systematic review. JCO Glob Oncol 2021; 7(1):311-323. https://doi.org/10.1200/GO.20.00639

Maringe C, Spicer J, Morris M, Purushotham A, Nolte E, Sullivan R, et al. 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(8):1023-1034. https://doi.org/10.1016/S1470-2045(20)30388-0

Powis M, Milley-Daigle C, Hack S, Alibhai S, Singh S, Krzyzanowska MK. Impact of the early phase of the COVID pandemic on cancer treatment delivery and the quality of cancer care: A scoping review and conceptual model. Int J Qualh Heal Care 2021; 33(2):mzab088. https://doi.org/10.1093/intqhc/mzab088

Murphy CT, Galloway TJ, Handorf EA, Egleston BL, Wang LS, Mehra R, et al. Survival impact of increasing time to treatment initiation for patients with head and neck cancer in the United States. J Clin Oncol 2016; 34(2):169. https://doi.org/10.1200%2FJCO.2015.61.5906

Chen Z, King W, Pearcey R, Kerba M, Mackillop WJ. The relationship between waiting time for radiotherapy and clinical outcomes: A systematic review of the literature. Radiother Oncol 2008; 87(1):3-16. https://doi.org/10.1016/j.radonc.2007.11.016

Waaijer A, Terhaard CH, Dehnad H, Hordijk GJ, Van Leeuwen MS, Raaymakers CP, et al. Waiting times for radiotherapy: Consequences of volume increase for the TCP in oropharyngeal carcinoma. Radiother Oncol 2003; 66(3):271-276. https://doi.org/10.1016/S0167-8140(03)00036-7

Jensen AR, Nellemann HM, Overgaard J. Tumor progression in waiting time for radiotherapy in head and neck cancer. Radiother Oncol 2007; 84(1):5-10. https://doi.org/10.1016/j.radonc.2007.04.001

Rygalski CJ, Zhao S, Eskander A, Zhan KY, Mroz EA, Brock G, et al. Time to surgery and survival in head and neck cancer. Ann Surg Oncol 2021; 28:877-885. https://doi.org/10.1245/s10434-020-09326-4

Xiao R, Ward MC, Yang K, Adelstein DJ, Koyfman SA, Prendes BL, et al. Increased pathologic upstaging with rising time to treatment initiation for head and neck cancer: A mechanism for increased mortality. Cancer 2018; 124(7):1400-1414. https://doi.org/10.1002/cncr.31213

Siakholak FR, Ghoncheh M, Pakzad R, Gandomani HS, Ghorat F, Salehiniya H. Epidemiology, incidence and mortality of oral cavity and lips cancer and their relationship with the human development index in the world. Biomed Res Ther 2016; 3:1-17. https://doi.org/10.7603/s40730-016-0048-y

Bonfante GMDS, Machado CJ, Souza PEAD, Andrade EIG, Acurcio FDA, Cherchiglia ML. Specific 5-year oral cancer survival and associated factors in cancer outpatients in the Brazilian Unified National Health System. Cad Saude Publ 2014; 30(5):983-997. https://doi.org/10.1590/0102-311X00182712

Soares EC, Neto BCB, Santos LPS. Epidemiological study of oral cancer in Brazil. Arq Med Hosp Fac Cienc Med Santa Casa São Paulo 2019; 64(3):192-198. https://doi.org/10.26432/1809-3019.2019.64.3.192

Ribeiro CM, Correa FDM, Migowski A. Short-term effects of the COVID-19 pandemic on cancer screening, diagnosis and treatment procedures in Brazil: A descriptive study, 2019-2020. Epidemiol Serv Saude 2022; 31:e2021405. https://doi.org/10.1590/S1679-49742022000100010

Cunha ARD, Velasco SRM, Hugo FN, Antunes JLF. Hospitalizations for oral and oropharyngeal cancer in Brazil by the SUS: Impacts of the covid-19 pandemic. Rev Saude Publ 2023; 57(S1):3s. https://doi.org/10.11606/s1518-8787.2023057004708

de Oliveira MM, Fuller TL, Gabaglia CR, Cambou MC, Brasil P, de Vasconcelos ZFM, et al. Repercussions of the COVID-19 pandemic on preventive health services in Brazil. Prev Med 2022; 155:106914. https://doi.org/10.1016/j.ypmed.2021.106914

Bigoni A, Malik AM, Tasca R, Carrera MBM, Schiesari LMC, Gambardella DD, et al. Brazil's health system functionality amidst of the COVID-19 pandemic: An analysis of resilience. Lancet Reg Health Am 2022; 10:100222. https://doi.org/10.1016/j.lana.2022.100222

Frio GS, Russo LX, de Albuquerque CP, da Mota LMH, Barros-Areal AF, Oliveira APRA, et al. The disruption of elective procedures due to COVID-19 in Brazil in 2020. Sci Rep 2022; 12(1):10942. https://doi.org/10.1038/s41598-022-13746-5

Hyeda A, da Costa ÉSM, Kowalski SC. The trend and direct costs of screening and chemotherapy treatment of breast cancer in the new coronavirus pandemic: Total and interrupted time series study. BMC Heal Serv Res 2022; 22(1):1466. https://doi.org/10.1186/s12913-022-08884-5

Hyeda A, da Costa ÉSM, Kowalski SC. The negative impact of the new coronavirus pandemic on the trend of breast biopsies and their direct costs: Interrupted time series analysis. Value Health Reg Iss 2023; 35:8-12. https://doi.org/10.1016/j.vhri.2023.01.004

Metzger K, Mrosek J, Zittel S, Pilz M, Held T, Adeberg S, et al. Treatment delay and tumor size in patients with oral cancer during the first year of the COVID‐19 pandemic. Head Neck 2021; 43(11):3493-3497. https://doi.org/10.1002/hed.26858

Blay JY, Boucher S, Le Vu B, Cropet C, Chabaud S, Perol D, et al. Delayed care for patients with newly diagnosed cancer due to COVID-19 and estimated impact on cancer mortality in France. ESMO Open 2021; 6(3):100134. https://doi.org/10.1016/j.esmoop.2021.100134

Sud A, Jones ME, Broggio J, Loveday C, Torr B, Garrett A, et al. Collateral damage: The impact on outcomes from cancer surgery of the COVID-19 pandemic. Ann Oncol 2020; 31(8):1065-1074. https://doi.org/10.1016/j.annonc.2020.05.00

Americas Health Foundation (AHF). The impact of the COVID-19 pandemic on cancer care in Latin America and the Caribbean. Available from: https://americashealthfoundation.org/wp-content/uploads/FINAL-AHF-COVID-19-Impact-Study-ENG-2022.pdf [Accessed on December 1, 2023].

Lima ALMDA, Borborema MDCD, Matos APR, Oliveira KMMD, Mello MJG, Lins MM. COVID-19 cohort on children with cancer: Delay in treatment and increased frequency of deaths. Rev Bras Saude Mat Inf 2021; 21:299-304. https://doi.org/10.1590/1806-9304202100S100017

Furness S, Glenny AM, Worthington HV, Pavitt S, Oliver R, Clarkson JE, et al. Interventions for the treatment of oral cavity and oropharyngeal cancer: Chemotherapy. Cochr Database Syst Rev 2011; 4:CD006386 https://doi.org/10.1002/14651858.CD006386.pub3

Richards M, Anderson M, Carter P, Ebert BL, Mossialos E. The impact of the COVID-19 pandemic on cancer care. Nat Cancer 2020; 1(6):565-567. https://doi.org/10.1038/s43018-020-0074-y

Marijnen CAM, Peters FP, Rödel C, Bujko K, Haustermans K, Fokas E, et al. International expert consensus statement regarding radiotherapy treatment options for rectal cancer during the COVID 19 pandemic. Radiother Oncol 2020; 148:213-215. https://doi.org/10.1016/j.radonc.2020.03.039

Vordermark D. Shift in indications for radiotherapy during the COVID-19 pandemic? A review of organ-specific cancer management recommendations from multidisciplinary and surgical expert groups. Rad Oncol 2020; 15(1):140. https://doi.org/10.1186/s13014-020-01579-3

Siavashpour Z, Goharpey N, Mobasheri M. Radiotherapy based management during Covid-19 pandemic – A systematic review of presented consensus and guidelines. Crir Rev Oncol Hematol 2021; 164:103402. https://doi.org/10.1016/j.critrevonc.2021.103402

Borges DMDL, Sena MFD, Ferreira MAF, Roncalli AG. Mortality for oral cancer and socioeconomic status in Brazil. Cad Saude Publ 2009; 25(2):321-327. https://doi.org/10.1590/S0102-311X2009000200010