Survival of patients with malignant neoplasms to be screened as part of the adult medical examination during the COVID-19 pandemic

Purpose of the study. To assess the variations of survival in malignant neoplasms subject to screening as part of the regular adult population check-up (index MN, iMN) during the COVID-19 pandemic according to the data of the Arkhangelsk Regional Cancer Registry (ARCR).

Materials and methods. Data on nine iMN in the Arkhangelsk region were extracted from the ARCR database. Using the actuarial method, 1-year cancer-specific (CSS) and overall (OS) survival were estimated during the COVID-19 pandemic in 2020–2021. This period was compared with the 2018–2019 period before the pandemic. Differences between the periods were assessed using the log-rank method. Cox regression analysis was used to identify possible causes of differences in survival between the periods.

Results. A total of 12,354 records of nine iMNs were selected to analyze the survival during the COVID-19 pandemic. For all malignant neoplasms, there was a decrease in the one-year OSR rates, which was statistically significant for lung cancer (from 42.4 % to 32.8 %, p = 0.0001) and cervical cancer (from 90.3 % to 80.8 %, p = 0.02), and OS (by 2.6 %–11.0 %, significant for seven of the nine iMNs). Compared with the pre-COVID period, during the pandemic, the proportion of deaths of patients with iMNs from respiratory diseases increased by 1.5 times and the proportion of deaths from external causes increased from 3 % to 9 %, chi-square (4) = 41.8, p = 0.00001. In the regression models of CSS and OS, after adjusting for stage, the hazard ratio decreased from 1.15 (95 % confidence interval (CI) 1.07–1.24) to 1.10 (95 % CI 1.03–1.19) and from 1.22 (95 % CI 1.14–1.31) to 1.18 (95 % CI 1.10–1.26). In multivariable regression, the risk of cancer-specific and all-cause death in patients with malignant neoplasms during the pandemic remained higher by 16 % and 24 %.

Conclusion. The 15–33 % higher risk of cancer-specific and all-cause death during the COVID-19 pandemic is explained by an increase in the proportion of advanced stages due to limited access to screening. Longer-term survival analysis is required.

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