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COVID-19 and liver cancer: lost patients and larger tumours

Geh, Daniel, Watson, Robyn, Sen, Gourab, French, Jeremy J, Hammond, John, Turner, Paul, Hoare, Tim, Anderson, Kirsty, McNeil, Michael, McPherson, Stuart, Masson, Steven, Dyson, Jessica, Donnelly, Mhairi, MacDougal, Louise, Patel, Preya, Hudson, Mark, Anstee, Quentin M, White, Steven, Robinson, Stuart, Pandanaboyana, Sanjay, Walker, Lucy, McCain, Misti, Bury, Yvonne, Raman, Shreya, Burt, Alastair, Parkinson, Daniel, Haugk, Beate, Darne, Antony, Wadd, Nick, Asghar, Syed, Mariappan, Lavanya, Margetts, Jane, Stenberg, Benjamin, Scott, John, Littler, Peter, Manas, Derek M and Reeves, Helen L (2022) COVID-19 and liver cancer: lost patients and larger tumours. BMJ Open Gastroenterology, 9 (1). e000794. ISSN 2054-4774

Item Type: Article

Abstract

Background Northern England has been experiencing a persistent rise in the number of primary liver cancers, largely driven by an increasing incidence of hepatocellular carcinoma (HCC) secondary to alcohol-related liver disease and non-alcoholic fatty liver disease. Here we review the effect of the COVID-19 pandemic on primary liver cancer services and patients in our region.
Objective To assess the impact of the COVID-19 pandemic on patients with newly diagnosed liver cancer in our region.
Design We prospectively audited our service for the first year of the pandemic (March 2020–February 2021), comparing mode of presentation, disease stage, treatments and outcomes to a retrospective observational consecutive cohort immediately prepandemic (March 2019–February 2020).
Results We observed a marked decrease in HCC referrals compared with previous years, falling from 190 confirmed new cases to 120 (37%). Symptomatic became the the most common mode of presentation, with fewer tumours detected by surveillance or incidentally (% surveillance/incidental/symptomatic; 34/42/24 prepandemic vs 27/33/40 in the pandemic, p=0.013). HCC tumour size was larger in the pandemic year (60±4.6 mm vs 48±2.6 mm, p=0.017), with a higher incidence of spontaneous tumour haemorrhage. The number of new cases of intrahepatic cholangiocarcinoma (ICC) fell only slightly, with symptomatic presentation typical. Patients received treatment appropriate for their cancer stage, with waiting times shorter for patients with HCC and unchanged for patients with ICC. Survival was associated with stage both before and during the pandemic. 9% acquired COVID-19 infection.
Conclusion The pandemic-associated reduction in referred patients in our region was attributed to the disruption of routine healthcare. For those referred, treatments and survival were appropriate for their stage at presentation. Non-referred or missing patients are expected to present with more advanced disease, with poorer outcomes. While protective measures are necessary during the pandemic, we recommend routine healthcare services continue, with patients encouraged to engage.

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More Information

Depositing User: Shreya Raman

Identifiers

Item ID: 19029
Identification Number: https://doi.org/10.1136/bmjgast-2021-000794
ISSN: 2054-4774
URI: http://sure.sunderland.ac.uk/id/eprint/19029
Official URL: http://dx.doi.org/10.1136/bmjgast-2021-000794

Users with ORCIDS

ORCID for Shreya Raman: ORCID iD orcid.org/0009-0006-8915-8286

Catalogue record

Date Deposited: 07 May 2025 09:46
Last Modified: 07 May 2025 09:46

Contributors

Author: Shreya Raman ORCID iD
Author: Daniel Geh
Author: Robyn Watson
Author: Gourab Sen
Author: Jeremy J French
Author: John Hammond
Author: Paul Turner
Author: Tim Hoare
Author: Kirsty Anderson
Author: Michael McNeil
Author: Stuart McPherson
Author: Steven Masson
Author: Jessica Dyson
Author: Mhairi Donnelly
Author: Louise MacDougal
Author: Preya Patel
Author: Mark Hudson
Author: Quentin M Anstee
Author: Steven White
Author: Stuart Robinson
Author: Sanjay Pandanaboyana
Author: Lucy Walker
Author: Misti McCain
Author: Yvonne Bury
Author: Alastair Burt
Author: Daniel Parkinson
Author: Beate Haugk
Author: Antony Darne
Author: Nick Wadd
Author: Syed Asghar
Author: Lavanya Mariappan
Author: Jane Margetts
Author: Benjamin Stenberg
Author: John Scott
Author: Peter Littler
Author: Derek M Manas
Author: Helen L Reeves

University Divisions

Faculty of Health Sciences and Wellbeing > School of Medicine

Subjects

Sciences > Health Sciences
Sciences

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