The impact of the COVID-19 pandemic on diagnosis and treatment of patients with soft tissue and bone sarcomas or aggressive benign musculoskeletal diseases: A single-center retrospective study (SarCorD study)

Concetta Elisa Onesti; Sabrina Vari; Francesca Nardozza; Gabriella Maggi; Denise Minghelli; Barbara Rossi; Francesca Sperati; Elisa Checcucci; Wioletta Faltyn; Maria Cecilia Cercato; Antonella Cosimati; Roberto Biagini; Gennaro Ciliberto; Virginia Ferraresi

doi:10.3389/fonc.2022.1000056

The impact of the COVID-19 pandemic on diagnosis and treatment of patients with soft tissue and bone sarcomas or aggressive benign musculoskeletal diseases: A single-center retrospective study (SarCorD study)

Front Oncol. 2022 Sep 20:12:1000056. doi: 10.3389/fonc.2022.1000056. eCollection 2022.

Authors

Affiliations

¹ Sarcomas and Rare Tumors Unit, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy.
² Unità Operativa Semplice Dipartimentale (UOSD) Clinical Trial Center, Biostatistics and Bioinformatics, IRCCS Regina Elena National Cancer Institute, Rome, Italy.
³ Psychology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy.
⁴ Oncological Orthopaedics Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy.
⁵ UOSD Clinical Trial Center, Biostatistics and Bioinformatics, IRCCS San Gallicano Dermatological Institute, Rome, Italy.
⁶ Epidemiology and Tumor Registry Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy.
⁷ Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy.
⁸ Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy.

Abstract

Background: The COVID-19 pandemic led to a rapid reorganization of healthcare activities, leading to reduced access to clinics, interruption of screenings, and treatment schedule modifications in several cancer types. Few data are available on sarcomas. We analyzed COVID-19-related diagnostic delay in a sarcoma referral center in Italy.

Methods: We retrospectively enrolled in this study patients with histological diagnosis of soft tissue or bone sarcoma and aggressive benign musculoskeletal diseases obtained during the first year of the pandemic (Covid group) or the year before (Control group) and followed at the Regina Elena National Cancer Institute in Rome. The primary endpoint was the time from the first symptom to histological diagnosis.

Results: We evaluated 372 patients, 185 of whom were eligible for primary endpoint analysis (92 patients in the Control group and 93 patients in the Covid group). The patients were affected by soft tissue sarcoma in most cases (63.0% and 66.7% in Covid and Control groups, respectively). We observed a diagnostic delay in the Covid group with a median time from the first symptom to the definitive histological diagnosis of 103.00 days (95% CI 92.77-113.23) vs. 90.00 days (95% CI 69.49-110.51) in the Control group (p = 0.024), but not a delay in treatment beginning (151 days, 95% CI 132.9-169.1 vs. 144 days, 95% CI 120.3-167.7, respectively, p = 0.208). No differences in stage at diagnosis were observed (12% vs. 16.5% of patients with metastatic disease at diagnosis in the Covid and Control groups, respectively, p = 0.380). Progression-free survival (p = 0.897) and overall survival (p = 0.725) were comparable in the subgroup of patients affected by soft tissue sarcoma.

Conclusions: A delay in sarcoma diagnosis but not in starting treatment has been observed during the first year of the COVID-19 pandemic. Nevertheless, no difference in stage at diagnosis or in terms of survival has been observed.

Keywords: COVID-19; aggressive benign musculoskeletal diseases; bone sarcoma; diagnostic delay; pandemic; soft tissue sarcoma.