Treatment of oropharyngeal cancer during the COVID-19 lockdown - outcomes for patients treated during the pandemic

Background: The onset of the coronavirus disease 2019 (COVID-19) outbreak caused major interruptions to the entire healthcare network affecting referral, diagnosis and treatment pathways with the potential to affect cancer treatment outcomes. In Ireland a national lockdown was initiated in March 2020 involving a stay-at-home order with a limitation on travel, social interactions and closure of schools, universities and childcare facilities. We designed a retrospective study comparing treatment outcomes for patients with oropharyngeal cancer treated before and during the COVID pandemic.

Materials and methods: All patients receiving radical radiotherapy for oropharyngeal cancer pre-COVID (July 17 - July 18) and during COVID (Mar 20 - Mar 21) were included. Patient and disease characteristics, diagnostic timelines, treatment delays and disease outcomes were extracted from the patient record. Disease free survival and overall survival were calculated for both groups.

Results: 159 oropharynx patients were included, 76 in the pre-COVID group (Group 1) and 83 in the pandemic group (Group 2). When comparing Group 1 and 2, respectively: There were no differences in human papilloma virus (HPV) status (74% vs. 71% p = 0.795) or Tumour-Node-Metastasis (TNM) overall stage [American Joint Committee on Cancer (AJCC) ed. 8]: (Stage 1: 25% vs. 45.8%, Stage 2: 28.9% vs. 18.1%, Stage 3: 21% vs. 15.7%, Stage 4: 25% vs. 20.5%, p = 0.268). Use of moderate hypofractionated regime increased during the pandemic (2.6% to 10.8%) and one patient omitted chemotherapy due to COVID-related reasons. There was no change in overall treatment times between groups with COVID-related sepsis accounting for one significant delay and one death during treatment. Overall survival at 2 years via Kaplan-Meier analysis; Group 1 cumulative proportion surviving at 2 years was 77% [95% confidence interval (CI): 67-86%] vs. 85% in Group 2 (95% CI: 77-93%, p = 0.35). The disease free survival at 2 years was 69% in Group 1 (95% CI: 59-80%) vs. 76% in Group 2 (95% CI: 67-85%, p = 0.567).

Conclusion: In spite of challenges related to the COVID-19 pandemic, we have demonstrated that oropharyngeal cancer patients treatment standards and outcomes were maintained. We did not demonstrate any significant difference in overall survival and disease free survival at 2 years when compared to a similar group prior to the pandemic.