Impact of the COVID-19 pandemic on disease stage and treatment for patients with pancreatic adenocarcinoma: A French comprehensive multicentre ambispective observational cohort study (CAPANCOVID)

Mathias Brugel (1, 2) , Léa Letrillart (1, 2) , Camille Evrard (3) , Aurore Thierry (1) , David Tougeron (3) , Mehdi El Amrani (4, 5) , Guillaume Piessen (4, 5) , Stéphanie Truant (4, 5) , Anthony Turpin (4, 5) , Christelle d'Engremont (6, 7) , Gaël Roth (6, 7) , Vincent Hautefeuille (8) , Jean-Marc Regimbeau (9, 10) , Nicolas Williet (11) , Lilian Schwarz (12, 13) , Frédéric Di Fiore (12, 13) , Christophe Borg (14, 15, 16) , Alexandre Doussot (14) , Aurélien Lambert (17) , Valérie Moulin (18) , Hélène Trelohan (18) , Marion Bolliet (19) , Amalia Topolscki (19) , Ahmet Ayav (20) , Anthony Lopez (20, 21) , Damien Botsen (2, 1, 22) , Tullio Piardi (1, 23) , Claire Carlier (2, 1, 22) , Olivier Bouché (2, 1)

1 Hôpital universitaire Robert Debré [Reims]
2 URCA - Université de Reims Champagne-Ardenne
3 CHU de Poitiers - Centre hospitalier universitaire de Poitiers = Poitiers University Hospital
4 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
5 CANTHER - Cancer Heterogeneity, Plasticity and Resistance to Therapies - UMR 9020 - U 1277
6 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
7 UGA - Université Grenoble Alpes
8 CHU Amiens-Picardie
9 Chirurgie digestive [CHU Amiens]
10 SSPC - Simplification des soins chez les patients complexes - UR UPJV 7518
11 CHU ST-E - Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne]
12 Service de Chirurgie Digestive [CHU Rouen]
13 GPMCND - Génomique et Médecine Personnalisée du Cancer et des Maladies Neuropsychiatriques
14 CHRU Besançon - Centre Hospitalier Régional Universitaire de Besançon
15 EFS BFC (site de Dijon) - Etablissement Français du Sang de Bourgogne Franche-Comté (site de Dijon)
16 RIGHT - Interactions hôte-greffon-tumeur, ingénierie cellulaire et génique - UFC (UMR INSERM 1098)
17 UNICANCER/ICL - Institut de Cancérologie de Lorraine - Alexis Vautrin [Nancy]
18 Groupe hospitalier de La Rochelle
19 CH Colmar
20 CHRU Nancy - Centre Hospitalier Régional Universitaire de Nancy
21 NGERE - Nutrition-Génétique et Exposition aux Risques Environnementaux
22 Institut Jean Godinot [Reims]
23 VIEFRA - EA 3797 - Vieillissement, Fragilité

Background: The COVID-19 pandemic caused major oncology care pathway disruption. The CAPANCOVID study aimed to evaluate the impact on pancreatic adenocarcinoma (PA) - from diagnosis to treatment - of the reorganisation of the health care system during the first lockdown. Methods: This multicentre ambispective observational study included 833 patients diagnosed with PA between September 1, 2019 and October 31, 2020 from 13 French centres. Data were compared over three periods defined as before the outbreak of COVID-19, during the first lockdown (March 1 to May 11, 2020) and after lockdown. Results: During the lockdown, mean weekly number of new cases decreased compared with that of pre-pandemic levels (13.2 vs. 10.8, -18.2%; p = 0.63) without rebound in the post-lockdown period (13.2 vs. 12.9, -1.7%; p = 0.97). The number of borderline tumours increased (13.6%-21.7%), whereas the rate of metastatic diseases rate dropped (47.1%-40.3%) (p = 0.046). Time-to-diagnosis and -treatment were not different over periods. Waiting neoadjuvant chemotherapy in resectable tumours was significantly favoured (24.7%-32.6%) compared with upfront surgery (13%-7.8%) (p = 0.013). The use of mFOLFIRINOX preoperative chemotherapy regimen decreased (84.9%-69%; p = 0.044). After lockdown, the number of borderline tumours decreased (21.7%-9.6%) and advanced diseases increased (59.7%-69.8%) (p = 0.046). SARS-CoV-2 infected 39 patients (4.7%) causing 5 deaths (12.8%). Conclusion: This cohort study suggests the existence of missing diagnoses and of a shift in disease stage at diagnosis from resectable to advanced diseases with related therapeutic modifications whose prognostic consequences will be known after the planned follow-up. Trial registration: Clinicaltrials.gov NCT04406571.

Mots clés: COVID-19; Cancer; Care pathway; Pancreatic neoplasms; Pandemic; SARS-CoV-2

Domaines: Médecine humaine et pathologie

Mathias Brugel, Léa Letrillart, Camille Evrard, Aurore Thierry, David Tougeron, et al.. Impact of the COVID-19 pandemic on disease stage and treatment for patients with pancreatic adenocarcinoma: A French comprehensive multicentre ambispective observational cohort study (CAPANCOVID). European Journal of Cancer, 2022, 166, pp.8-20. ⟨10.1016/j.ejca.2022.01.040⟩. ⟨hal-03638373⟩