How the COVID-19 Pandemic Impacted on Integrated Care Pathways for Lung Cancer: The Parallel Experience of a COVID-Spared and a COVID-Dedicated Center

Giulia Pasello; Jessica Menis; Sara Pilotto; Stefano Frega; Lorenzo Belluomini; Federica Pezzuto; Anna Caliò; Matteo Sepulcri; Nunzia Luna Valentina Cernusco; Marco Schiavon; Maurizio Valentino Infante; Marco Damin; Claudio Micheletto; Paola Del Bianco; Riccardo Giovannetti; Laura Bonanno; Umberto Fantoni; Valentina Guarneri; Fiorella Calabrese; Federico Rea; Michele Milella; PierFranco Conte

doi:10.3389/fonc.2021.669786

How the COVID-19 Pandemic Impacted on Integrated Care Pathways for Lung Cancer: The Parallel Experience of a COVID-Spared and a COVID-Dedicated Center

Front Oncol. 2021 Jun 28:11:669786. doi: 10.3389/fonc.2021.669786. eCollection 2021.

Authors

Giulia Pasello^{1

2}, Jessica Menis^{1

2}, Sara Pilotto³, Stefano Frega¹, Lorenzo Belluomini³, Federica Pezzuto⁴, Anna Caliò⁵, Matteo Sepulcri⁶, Nunzia Luna Valentina Cernusco⁷, Marco Schiavon⁴, Maurizio Valentino Infante⁸, Marco Damin⁴, Claudio Micheletto⁸, Paola Del Bianco¹, Riccardo Giovannetti⁸, Laura Bonanno¹, Umberto Fantoni⁴, Valentina Guarneri^{1

2}, Fiorella Calabrese⁴, Federico Rea⁴, Michele Milella³, PierFranco Conte^{1

2}

Affiliations

¹ Medical Oncology Department, Istituto Oncologico Veneto IRCCS, Padova, Italy.
² Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy.
³ Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy.
⁴ University of Padova, Medical School, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova, Italy.
⁵ Department of Diagnostics and Public Health, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy.
⁶ Radiation Oncology Department, Istituto Oncologico Veneto IRCCS, Padova, Italy.
⁷ Radiation Oncology Department, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy.
⁸ Cardiovascular and Thoracic Department, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy.

Abstract

Introduction: The COVID-19 pandemic has proved to be a historic challenge for healthcare systems, particularly with regard to cancer patients. So far, very limited data have been presented on the impact on integrated care pathways (ICPs).

Methods: We reviewed the ICPs of lung cancer patients who accessed the Veneto Institute of Oncology (IOV)/University Hospital of Padua (Center 1) and the University Hospital of Verona (Center 2) before and after the COVID-19 pandemic, through sixteen indicators chosen by the members of a multidisciplinary team (MDT).

Results: Two window periods (March and April 2019 and 2020) were chosen for comparison. Endoscopic diagnostic procedures and major resections for early stage NSCLC patients increased at Center 1, where a priority pathway with dedicated personnel was established for cancer patients. A slight decrease was observed at Center 2 which became part of the COVID unit. Personnel shortage and different processing methods of tumor samples determined a slightly longer time for diagnostic pathway completion at both Centers. Personnel protection strategies led to a MDT reshape on a web basis and to a significant selection of cases to be discussed in both Centers. The optimization of patient access to healthcare units reduced first outpatient oncological visits, patient enrollment in clinical trials, and end-of-life cancer systemic treatments; finally, a higher proportion of hypofractionation was delivered as a radiotherapy approach for early stage and locally advanced NSCLC.

Conclusions: Based on the experience of the two Centers, we identified the key steps in ICP that were impacted by the COVID-19 pandemic so as to proactively put in place a robust service provision of thoracic oncology.

Keywords: COVID-19; integrated care pathway; lung cancer; multidisciplinary team discussion; pandemic.

Copyright © 2021 Pasello, Menis, Pilotto, Frega, Belluomini, Pezzuto, Caliò, Sepulcri, Cernusco, Schiavon, Infante, Damin, Micheletto, Del Bianco, Giovannetti, Bonanno, Fantoni, Guarneri, Calabrese, Rea, Milella and Conte.