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Einfluss der COVID-19-Pandemie auf die Diagnostik und Therapie bei Patienten mit Kopf-Hals-Tumoren in Brandenburg und Berlin

Impact of the COVID-19 pandemic on the diagnosis and treatment of patients with head and neck cancer in Brandenburg and Berlin

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Zusammenfassung

Hintergrund

Der Einfluss der COVID-19-Pandemie auf mögliche Einschränkungen bei der Diagnostik und Therapie von Patienten mit Kopf-Hals-Tumoren ist bisher noch nicht ausreichend untersucht. Es liegen hierzu widersprüchliche Angaben vor. Daten von größeren Patientenkollektiven existieren für Deutschland bisher nicht.

Fragestellung

Ziel der Erhebung war es, an einer großen Kohorte zu klären, ob die COVID-19-Pandemie einen Einfluss auf die Diagnostik und Therapie von Patienten mit Kopf-Hals-Tumoren hatte.

Methode

Es erfolgte eine retrospektive Datenanalyse der Meldedaten des Klinisch-epidemiologischen Krebsregisters Brandenburg-Berlin gGmbH (KKRBB) von 4831 Fällen mit Kopf-Hals-Tumor aus den Jahren 2018 bis 2020. Der Zeitraum vor dem 01. April 2020 wurde als Prä-Pandemie-Kohorte gewertet und mit den Fällen der Pandemie-Kohorte ab dem 1. April 2020 bis 31. Dezember 2020 in Bezug auf patientenbezogene Basisdaten, Tumorlokalisation, Tumorstadium, Tumorboards und durchgeführte Therapien verglichen.

Ergebnisse

Es konnten keine Unterschiede zwischen der Prä-Pandemie- und der Pandemie-Kohorte in Bezug auf patientenbezogene Basisdaten, Tumorlokalisation und Tumorstadium beobachtet werden. Ebenso war keine zeitliche Verzögerung bei Diagnostik, Tumorboards und Therapie in der Pandemiezeit zu erkennen. Im Gegenteil, das Zeitintervall zwischen Diagnosestellung und Therapiebeginn verkürzte sich im Durchschnitt um 2,7 Tage in der Pandemie-Phase. Tumoren mit T4-Stadium wurden während der Pandemie im Vergleich zum Zeitraum davor häufiger operativ therapiert (20,8 % vs. 29,6 %), wohingegen primäre Radio(chemo)therapien in der Pandemie zurückgingen (53,3 % vs. 40,4 %). Für alle anderen Tumorstadien und Entitäten bestanden bei der Therapie keine Unterschiede.

Schlussfolgerung

Entgegen der anfänglichen Mutmaßung, dass die COVID-19-Pandemie zu einem Rückgang an Tumorfällen, größeren Tumorstadien bei Erstvorstellung und einer Verzögerung in der Diagnostik und Therapie geführt haben könnte, zeigt sich an der untersuchten Kohorte für Brandenburg und Berlin weder eine Verzögerung in der Tumorbehandlung noch eine Zunahme der Tumorgröße und des Stadiums bei Erstvorstellung. Die durchgeführten Therapien hingegen unterliegen einer Veränderung zugunsten des operativen Vorgehens, und es bleibt abzuwarten, ob dieser Trend auf lange Sicht erhalten bleibt.

Abstract

Background

The impact of the COVID-19 pandemic on potential limitations to the diagnosis and treatment of patients with head and neck tumours has not yet been adequately investigated. There are contradictory data on this subject. Data from larger patient collectives do not exist for Germany so far.

Objective

The aim of the survey was to clarify in a large cohort whether the COVID-19 pandemic had an influence on the diagnosis and treatment of patients with head and neck tumours.

Methods

A retrospective data analysis of the reporting data of the Clinical and Epidemiological Cancer Registry of Brandenburg and Berlin (Klinisch-epidemiologischen Krebsregisters Brandenburg-Berlin, KKRBB) of 4831 cases with head and neck tumours from 2018 to 2020 was performed. The period before April 01, 2020, was evaluated as a prepandemic cohort and compared with the cases of the pandemic cohort from April 1, 2020, until December 31, 2020, in terms of patient-related baseline data, tumour location, tumour stage, tumour board and treatments administered.

Results

No differences were observed between the prepandemic and pandemic cohorts with regard to patient-related baseline data, tumour localisation and tumour stage. Likewise, no temporal delay in diagnosis, tumour board and treatment was evident during the pandemic period. On the contrary, the time interval between diagnosis and start of therapy was shortened by an average of 2.7 days in the pandemic phase. Tumours with T4 stage were more frequently treated surgically during the pandemic compared to the period before (20.8% vs. 29.6%), whereas primary radio(chemo)therapy decreased during the pandemic (53.3% vs. 40.4%). For all other tumour stages and entities, there were no differences in treatment.

Conclusion

Contrary to initial speculation that the COVID-19 pandemic may have led to a decrease in tumour cases, larger tumour stages at initial presentation and a delay in diagnosis and treatment, the cohort studied for Brandenburg and Berlin showed neither a delay in tumour treatment nor an increase in tumour size and stage at initial presentation. The treatments performed, however, were subject to a change in favour of surgery and it remains to be seen whether this trend will be maintained in the long term.

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Danksagung

Der Dank der Autoren gilt Frau Bettina Frey für die Unterstützung bei der Aufbereitung der Daten.

Förderung

Das Forschungsvorhaben wurde von der Landesarbeitsgemeinschaft Onkologische Versorgung Brandenburg e. V. gefördert (Nr. 3.2.3, Datum: 19.12.2022).

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Authors and Affiliations

  1. Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Carl-Thiem-Klinikum, Thiemstr. 111, 03048, Cottbus, Deutschland

    Julia Carré &  Michael Herzog

  2. Klinisch-epidemiologisches Krebsregister Brandenburg-Berlin gGmbH, Dreifertstr. 12, 03044, Cottbus, Deutschland

    Beatrice Herzog, Daniela Reil, Constanze Schneider & Maren Pflüger

  3. Interdisziplinäre Studienzentrale des Carl-Thiem-Klinikums, Thiemstr. 111, 03048, Cottbus, Deutschland

    Madlen Löbel

  4. Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Straße 40, 01620, Halle (Saale), Deutschland

    Michael Herzog

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  1. Julia Carré
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Corresponding author

Correspondence to Michael Herzog.

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Interessenkonflikt

J. Carré, B. Herzog, D. Reil, C. Schneider, M. Pflüger, M. Löbel und M. Herzog geben an, dass kein Interessenkonflikt besteht.

Für die Studie lag ein positives Votum der Landesärztekammer Brandenburg mit Datum 22.02.2022 vor (Nr.: 2022-18-BO-ff). Die Studie ist im Deutschen Register Klinischer Studien registriert (DRKS00028983).

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Supplementary Information

106_2023_1396_MOESM1_ESM.pdf

Tab. S1 Anzahl der Tumormeldungen im zeitlichen Verlauf/Tab. S2 Lokalisation des Tumors gemäß ICD-10-Klassifikation/Tab. S3 Tumorstadien nach TNM und UICC für die allgemeine und c‑Klassifikation/Tab. S4 deskriptive Darstellung der Meldungen zu den jeweiligen Meldezeitpunkten (t1–t5)/Tab. S5 Darstellung des therapeutischen Vorgehens auf Basis der ersten gemeldeten Therapie vor und während der Pandemie in Abhängigkeit vom Tumorstadium/Tab. S6 Darstellung der zweiten Therapie nach operativer Ersttherapie

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Carré, J., Herzog, B., Reil, D. et al. Einfluss der COVID-19-Pandemie auf die Diagnostik und Therapie bei Patienten mit Kopf-Hals-Tumoren in Brandenburg und Berlin. HNO 72, 90–101 (2024). https://doi.org/10.1007/s00106-023-01396-6

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