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Abstract：
BACKGROUND: There is no updated national data regarding the real impact of the COVID-19 pandemic on delaying diagnosis and treatment among patients with lung, and head, and neck cancers in Brazil. This study aimed to analyze the COVID-19 pandemic impact on cancer diagnosis and clinical outcomes among lung, head, and neck cancer patients assisted in a tertiary cancer center in Southeastern Brazil, as well as to analyze these patients\' pretreatment clinical features.
METHODS: Retrospective cohort of patients with lung or head and neck cancer assisted in a tertiary cancer center in southeastern Brazil between January/2019 and December/2021. To assess statistical differences among groups [i.e., cohort 2019 versus (vs.) 2020 and 2019 vs. 2021] chi-square test was used with a 5% significance level and 90% power for sample size calculation. Differences among baseline clinical features and sociodemographic characteristics were evaluated either by T-test for two samples or Fisher\'s or Pearson\'s chi-square test (for quantitative or qualitative variables). All utilized tests had a 5% significance level.
RESULTS: Six hundred fifty-two patients were included, 332 with lung and 320 with head and neck cancer; it was observed a significant decrease in oncologic treatment recommendations and increase in palliative care recommendation for patients with lung cancer, despite similar stages at diagnosis. During the COVID-19 pandemic, more pain symptoms were reported at the first Oncology assessment for patients with head and neck cancer (p < 0.05). Compared to 2019, head and neck cancer patients diagnosed in 2021 presented a worse initial performance status (p = 0.008). There was a statistically significant increase in survival for patients diagnosed with head and neck cancer in 2021 when compared to 2019 (p = 0.003).
CONCLUSIONS: This research highlights low survival rates for patients with lung and head and neck cancer in Brazil, even before the pandemic started, as consequence of advanced diseases at diagnosis at the public health system and clinical degrading features. Additionally, there was an increase incidence in both lung cancer and head and neck cancer despite no differences in clinical stage. This reflects how fragile is the public healthcare system even before facing an acute public health crisis such as the COVID-19 pandemic. Yet, the total impact on public health may follow for many years.
METHODS: Retrospective cohort of patients with lung or head and neck cancer assisted in a tertiary cancer center in southeastern Brazil between January/2019 and December/2021. To assess statistical differences among groups [i.e., cohort 2019 versus (vs.) 2020 and 2019 vs. 2021] chi-square test was used with a 5% significance level and 90% power for sample size calculation. Differences among baseline clinical features and sociodemographic characteristics were evaluated either by T-test for two samples or Fisher\'s or Pearson\'s chi-square test (for quantitative or qualitative variables). All utilized tests had a 5% significance level.
RESULTS: Six hundred fifty-two patients were included, 332 with lung and 320 with head and neck cancer; it was observed a significant decrease in oncologic treatment recommendations and increase in palliative care recommendation for patients with lung cancer, despite similar stages at diagnosis. During the COVID-19 pandemic, more pain symptoms were reported at the first Oncology assessment for patients with head and neck cancer (p < 0.05). Compared to 2019, head and neck cancer patients diagnosed in 2021 presented a worse initial performance status (p = 0.008). There was a statistically significant increase in survival for patients diagnosed with head and neck cancer in 2021 when compared to 2019 (p = 0.003).
CONCLUSIONS: This research highlights low survival rates for patients with lung and head and neck cancer in Brazil, even before the pandemic started, as consequence of advanced diseases at diagnosis at the public health system and clinical degrading features. Additionally, there was an increase incidence in both lung cancer and head and neck cancer despite no differences in clinical stage. This reflects how fragile is the public healthcare system even before facing an acute public health crisis such as the COVID-19 pandemic. Yet, the total impact on public health may follow for many years.
摘要：
背景：没有关于COVID-19大流行对肺部患者延迟诊断和治疗的实际影响的最新国家数据，头，和巴西的颈部癌症。本研究旨在分析COVID-19大流行对肺癌诊断和临床结局的影响，头部,和颈部癌症患者在巴西东南部的三级癌症中心得到帮助，以及分析这些患者的预处理临床特征。
方法：回顾性队列研究了2019年1月至2021年12月在巴西东南部三级癌症中心协助治疗的肺癌或头颈部癌患者。评估组间的统计差异[即，2019年队列与(与)2020年和2019年与2021]卡方检验采用5%显著性水平和90%幂计算样本量。通过两个样本的T检验或Fisher或Pearson卡方检验（定量或定性变量）评估基线临床特征和社会人口统计学特征之间的差异。所有使用的测试具有5%的显著性水平。
结果：纳入了652例患者，332例肺癌和320例头颈部癌;观察到肺癌患者的肿瘤治疗建议显着减少，姑息治疗建议增加。尽管诊断阶段相似。在COVID-19大流行期间，头颈部癌症患者在首次肿瘤学评估时报告了更多的疼痛症状(p<0.05).与2019年相比，2021年诊断的头颈部癌症患者的初始表现较差（p=0.008）。与2019年相比，2021年被诊断为头颈癌的患者的生存率有统计学上的显着提高（p=0.003）。
结论：这项研究强调了巴西肺癌和头颈癌患者的低生存率，甚至在大流行开始之前，由于公共卫生系统诊断时的晚期疾病和临床退化特征。此外,尽管临床分期无差异,但肺癌和头颈癌的发病率均有增加.这反映出，在面临COVID-19大流行等急性公共卫生危机之前，公共医疗系统是多么脆弱。然而，对公共卫生的总体影响可能会持续多年。
方法：回顾性队列研究了2019年1月至2021年12月在巴西东南部三级癌症中心协助治疗的肺癌或头颈部癌患者。评估组间的统计差异[即，2019年队列与(与)2020年和2019年与2021]卡方检验采用5%显著性水平和90%幂计算样本量。通过两个样本的T检验或Fisher或Pearson卡方检验（定量或定性变量）评估基线临床特征和社会人口统计学特征之间的差异。所有使用的测试具有5%的显著性水平。
结果：纳入了652例患者，332例肺癌和320例头颈部癌;观察到肺癌患者的肿瘤治疗建议显着减少，姑息治疗建议增加。尽管诊断阶段相似。在COVID-19大流行期间，头颈部癌症患者在首次肿瘤学评估时报告了更多的疼痛症状(p<0.05).与2019年相比，2021年诊断的头颈部癌症患者的初始表现较差（p=0.008）。与2019年相比，2021年被诊断为头颈癌的患者的生存率有统计学上的显着提高（p=0.003）。
结论：这项研究强调了巴西肺癌和头颈癌患者的低生存率，甚至在大流行开始之前，由于公共卫生系统诊断时的晚期疾病和临床退化特征。此外,尽管临床分期无差异,但肺癌和头颈癌的发病率均有增加.这反映出，在面临COVID-19大流行等急性公共卫生危机之前，公共医疗系统是多么脆弱。然而，对公共卫生的总体影响可能会持续多年。
