Surgical Oncology before and during COVID-19 pandemic: an assessment through the data of the National Outcomes Evaluation Program – PNE

In Italy, COVID-19 had a strong impact on health care, quite evident for urgent hospitalization but more marked for scheduled admissions.
The aim of this study was to better understand the changes occurred in cancer care during the pandemic period (2020-2021) compared to the previous five years (2015-2019), in terms of differences in volumes, processes and outcomes, especially for breast cancer, for which screening is available, and lung cancer that instead does not benefit from any secondary prevention activity.
The study was conducted using data from the National Outcomes Evaluation Program (PNE), which analyses the hospital discharge records provided annually by more than 1,300 public and private Italian hospitals.
The findings show that in 2020 a marked reduction was observed in the number of all oncological interventions. In particular, for breast cancer surgery there was a decrease in 2020 of about 6,300 interventions (-10.1%) compared to 2019. With reference to the number of interventions per month of activity, the negative peak was observed in June 2020. Regarding surgical interventions for lung cancer, in 2020 there were about 1,000 interventions less than in 2019 (-8.6%). The negative peak observed in April 2020 was anticipated compared to breast cancer: in this case, there was no lagged effect on new diagnoses due to the suspension of screening programs. In 2021, there was a resumption of interventions that especially for the breast cancer led to a realignment to the pre-pandemic trend.
Our analysis has allowed to appreciate the resilience of the Italian hospital system to the pandemic emergency. However, it will take years to fully assess the impact of delayed or non-performed interventions on the worsening of clinical conditions, especially for the oncological diseases, as well as on the mortality indirectly attributable to COVID-19.

This manuscript stems from the need to evaluate the impact of Covid-19 on the Italian Hospital System. In particular, we analyzed the dynamics that characterized cancer care during the pandemic and the subsequent resumption of activities.

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