National data indicates fewer lung cancer diagnoses in 2020 than 2019 in England, but post-pandemic outcomes are not yet available (https://www.rcplondon.ac.uk/projects/outputs/nlca-annual-report-2022). We aimed to identify trends in lung cancer diagnosis in our hospital before, during and after the COVID-19 pandemic, ahead of national data.

We analysed cross-sectional incidence of all new lung cancers diagnosed at Darent Valley Hospital, UK over 4 months per year 2018-2022. Data included case numbers, diagnostic modality, cancer type and stage.

Lung cancers diagnosed in the 2020 cohort (n=38) were lower than in 2018 (n=66) and 2019 (n=61). This number recovered to pre-pandemic levels in 2021 (n=60) and 2022 (n=58). More patients had metastatic disease at presentation in 2020 (63.8%) compared to 2018 (52.8%, p=0.01) and 2019 (48.2%), but this fell in 2021 (54.4%, p=0.009 vs 2020) and 2022 (52.8%). M1c disease at presentation was more prevalent in 2020 (33.3%) compared to 2018 (18.9%, p=0.08) and 2019 (16.0%) and remains elevated in 2021 (35.1%, p=0.05 vs 2019) and 2022 (26.4%).

Following the drop in lung cancers diagnosed in 2020, an increase to greater than pre-pandemic levels could be anticipated in the recovery period. However, this is not seen, indicating ongoing impact of the pandemic. These missing diagnoses could also be related to COVID-19 deaths. The overrepresentation of M1c disease since 2020 implies delays in diagnosis, potentially related to disruption to primary and secondary care during the pandemic. These findings support calls for urgent measures to improve lung cancer outcomes, especially via earlier diagnosis, and possibly strengthen the case for screening in the post-pandemic era.