The Influence of the COVID-19 Pandemic on Lung Cancer Surgery in Queensland

The Coronavirus disease-19 (COVID-19) pandemic has posed unprecedented challenges to global healthcare, impacting the delivery of healthcare in all aspects of medicine. Due to the rapidly evolving and changing restrictions on the hospital system, the contemporary influence of COVID-19 on the delivery of lung cancer surgery has not been examined in Queensland. A retrospective registry analysis of the Queensland Cardiac Outcomes Registry (QCOR) Thoracic Database was conducted, examining all adult lung cancer resections across Queensland from 1 January 2016 to 22 April 2022. The data prior to and after the introduction of COVID-19 restrictions (March 2020) were compared. There were 1,207 patients. Mean age at surgery was 66 years and 1,115 (92%) lobectomies were performed. A significant delay from time of diagnosis to surgery was found from 80 to 96 days (p<0.0005) after introducing COVID restrictions. Prior to the pandemic, the average number of surgeries over time had increased from 128 in 2016 to 213 in 2019. This decreased after the pandemic and has not recovered (p=0.012). 2022 saw a sharp reduction in cases, with 49 surgeries compared with 71 in 2019 for the same period. This corresponded with interstate boarders opening and COVID-19 entering Queensland. COVID-19 restrictions were associated with a significant increase in pathological upstaging rates (IRR 0.9; CI 0.92–0.99; p=0.022). The greatest impact on upstaging was immediately after the introduction of COVID-19 restrictions (IRR 1.71; CI 0.99–2.9; p=0.05). COVID-19 significantly delayed the access to surgery, reduced surgical capacity, and consequently resulted in a trend toward pathological upstaging throughout Queensland.