Introduction
COVID-19 significantly disrupted referral pathways for cancer. This impact was detrimental for lung cancer, which is the third most common cancer in the United Kingdom. The aim of the audit was to determine whether changes in referral pathways influenced lung cancer diagnosis and staging.
Method
A retrospective data analysis of confirmed lung cancer cases from March 2018 to November 2022. Cases were divided ? pre-pandemic, from March 2018 to February 2020, and during the pandemic, from March 2020. The data was further divided by source of referral. Patients with non-lung primary cancer were excluded.
Results
876 patients were diagnosed with lung cancer from 03/2018 to 11/2022. 307 patients pre-pandemic and 569 during the pandemic. Mean age and gender distribution are comparable in both cohorts. 55% of patients were male and 45% were females, with an average age of 70.
Staging at diagnosis and 12-month mortality are summarised below:
| Stage | Pre - Pandemic staging (%) | During Pandemic - staging (%) | Pre Pandemic - 12 month mortality (%) | During Pandemic - 12 month mortality (%) |
| I | 2.6 | 5.0 | 2.2 | 1.9 |
| Ia | 1.6 | 4.0 | 1.6 | 1.2 |
| Ib | 0.9 | 1.0 | 0.6 | 0.7 |
| II | 2.2 | 3.3 | 0.9 | 1.0 |
| IIa | 0 | 0.3 | 0 | 0 |
| IIb | 2.2 | 2.9 | 0.9 | 0.5 |
| III | 17.5 | 16.5 | 8.1 | 7.5 |
| IIIa | 5.5 | 5.2 | 2.2 | 2.4 |
| IIIb | 7.1 | 7.5 | 3.9 | 3.1 |
| IIIc | 4.8 | 3.6 | 1.9 | 1.9 |
| IV | 63.8 | 63.8 | 32.2 | 42.5 |
| IVa | 33.8 | 28.1 | 15.9 | 17.5 |
| IVb | 28.9 | 34.2 | 15.9 | 23.9 |
Conclusion
Data shows an increase in the percentage of early stage lung cancers diagnosed during the pandemic compared to prior, although mortality rates at these stages were similar. This pattern was seen in primary care and hospital referrals.