Stage Migration in Newly Diagnosed Cancer Patients During the COVID-19 Pandemic Era

Background: We determined the effect of the ongoing COVID-19 pandemic on stage migration in the diagnosed cancer patients at a single cancer center in Korea where the social distancing recommendations were implemented but not the nationwide lockdown. Patients and Methods: We investigated the stages at the time of presentation in 873 newly diagnosed breast, gastric, colon, and thyroid cancer patients visiting Seoul National University Cancer Hospital during the eight weeks before (Nov 18, 2019 to Jan 10, 2020) and after (Apr 1. 2020 to May 29, 2020) the SARS-CoV-2 transmission spikes in Korea. Findings: We observed a significant stage migration in breast cancer patients toward more advanced stages (p<0.001). The incidence of stage III breast cancer increased from 8.4% in Pre-COVID-19 to 23.8% in Post-COVID-19. More than one third of the newly breast cancer patients during the Post-COVID-19 period underwent systemic chemotherapy as their first line of treatment (36.5% in Post-COVID-19 vs 23.0% in Pre-COVID-19, p=0.006). Similar trends of stage migration were also observed in patients with gastric and colon cancer but not in patients with thyroid cancer. Interpretation: Our data suggest that we are experiencing a potential shifting in disease severity in multiple cancer types during this unprecedented era of the COVID-19 pandemic. Healthcare providers as well as the oncologists should be aware of the possibility of this stage migration especially when their countries have adopted more strict measures such as the nationwide lockdown. Funding: None Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The acquisition of clinical and pathologic data from electric medical records of the cancer patients for this study was approved by the institutional IRB (2005-167-1125). All procedures were done in accordance with the Declaration of Helsinki.