Cancer represents the leading cause of mortality in Peru so
the number of oncologic centers has increased, favoring the decentralization of
cancer care during the past decade. Cancer is the second leading cause of death
globally, accounting for an estimated 9.6 million deaths, or 1 in 6 deaths, in
2018.
Purpose: The aim of this study is to evaluate the oncological care during the
first state of national emergency due to the COVID-19 pandemic in several
public cancer hospitals in Peru.
Materials and Methods: A multicentric cross-sectional descriptive study was
conducted by interviewing adult cancer patients diagnosed and treated between
January 2019 and February 2020 from 18 hospitals. This study was carried out in
September 2020, the last month of the first state of national emergency. Most
patients came from cities on the coast of Peru and the Instituto Nacional de
Enfermedades Neoplasicas (INEN). Demographic and clinical characteristics were
evaluated, including COVID-19 status and cancer treatment features.
Results: A total of 1472 patients were included; the median age was 55 years
(range 19–97). Most patients (85.8%, n = 1263) had solid neoplasia, 13.5% (n =
198) hematologic neoplasia, and 0.7% (n = 11) others. SARS-CoV-2 infection was
confirmed in 8.6% (n = 126), 1.2% (n = 18) were probable, 1.6% (n = 24) suspected,
and 88.6% (n = 1304) negative cases. Overall, 51.6% of patients (n = 759) had
cancer treatment delays, 42.5% (n = 626) changed treatment delivery (endovenous
to oral systemic therapy), and 12.6% (n = 185) of cases cancer therapy was
discontinued. In total, 10.3% (n = 117) of patients whose disease was
controlled or in remission, experienced progression of disease during the state
of emergency. A total of 6.7% (n = 98) of patients died, of whom 73.5% (n = 72)
died from disease progression; 18.4% (n = 18) from SARS-CoV-2 infection and
8.1% (n = 8) from undetermined causes. Patients with hematological malignancies
[hazard ratio (HR): 5.11 (95% confidence interval (CI): 1.99–13.07)] and no
response to therapy before the onset of the pandemic [5.01 (1.44–17.42)] had an
increased risk of death among COVID-19 infected individuals, whereas advanced
clinical stage [5.09 (2.37–10.95)] and discontinuation of treatment [3.66
(1.97–6.78)] were risk factors among non-COVID-19 patients. The finding clearly
shows the Peruvian healthcare system’s inequities. Poverty and limited access
to communication technology played an important role when telemedicine was
proposed as an alternative for patient encounters.
Conclusion: This study suggests that the COVID-19 pandemic has an adverse
impact on the outcomes of Peruvian cancer patients. In this cohort, cancer
mortality was higher than COVID-19 disease mortality. Management of cancer
patients in this pandemic constitutes a challenge, which must be carried out
within a multidisciplinary team along with public health policies to avoid the
COVID-19 disease spread, while, considering the risks/benefits of cancer
treatment.
Author(s) Details:
Natalia Valdiviezo,
Departamento de Medicina Oncológica, Instituto Nacional de
Enfermedades Neoplásicas, Lima, 15038, Peru.
Shirley Quintana
Truyenque,
Departamento
de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima,
15038, Peru.
Cindy Alcarraz,
Departamento de Medicina Oncológica, Instituto Nacional de
Enfermedades Neoplásicas, Lima, 15038, Peru and Escuela Profesional de Medicina
Humana, Universidad Privada San Juan Bautista, Lima, Perú.
Denisse Castro,
Departamento de Oncología Médica, Hospital Nacional Edgardo
Rebagliati Martins, Lima, 15072, Peru and Centro de Investigación de Medicina
de Precisión, Universidad de San Martin de Porres, Lima, 15024, Peru.
Renzo Salas,
Departamento de Oncología Médica, Hospital Nacional Edgardo
Rebagliati Martins, Lima, 15072, Peru.
César Carpio Luna,
Departamento
de Medicina Oncológica, Instituto Regional de Enfermedades Neoplásicas Sur,
Arequipa, Perú.
Marco Galvez-Villanueva,
Departamento de Medicina Oncológica, Instituto Regional de
Enfermedades Neoplásicas Norte, La Libertad, Perú.
Jorge Luis Huamanchumo Baca,
Departamento de Medicina Oncológica, Instituto Regional de
Enfermedades Neoplásicas Norte, La Libertad, Perú.
Luz Medina Aguirre,
Departamento de Medicina Oncológica, Hospital Goyeneche, Arequipa, 04600, Perú.
Fabio Eduardo Vega Centeno Bueno,
Departamento de Medicina Oncológica, Hospital Goyeneche, Arequipa, 04600, Perú.
Elica García-León,
Departamento de Medicina Oncológica, Hospital Regional de Lambayeque,
Lambayeque, 14001, Perú.
Isela Quispe-Santivañez,
Departamento de Medicina Oncológica, Hospital Santa Rosa, Lima, 15084, Peru.
Sandi Carmona Lozano,
Departamento de Medicina Oncológica, Hospital Santa Rosa, Lima, 15084, Peru.
Guillermo León Quispe,
Departamento de Medicina Oncológica, Hospital Nacional Dos de Mayo, Lima, Peru.
Eduardo Paz-Cornejo,
Departamento de Medicina Oncológica, Hospital Nacional Alberto Sabogal
Sologuren, Lima, Peru.
Luis Sánchez-Vilela,
Departamento de Medicina Oncológica, Hospital de Apoyo II Santa Rosa, Piura,
Peru.
Vanessa Bermúdez-Alfaro,
Departamento de Medicina Oncológica, Hospital Nacional Guillermo Almenara
Irigoyen, Lima, 15033, Peru.
José Luis Montoya Suárez,
Departamento de Medicina Oncológica, Hospital Nacional Guillermo Almenara
Irigoyen, Lima, 15033, Peru.
Juan Carlos Vargas-Nina,
Departamento de Medicina Oncológica, Hospital II EsSalud de Cajamarca,
Cajamarca, Peru.
Carlos Pérez-Ramos,
Departamento de Medicina Oncológica, Hospital María Auxiliadora, Lima,
Peru.
Andrea Meza-Hoces,
Departamento de Medicina Oncológica, Hospital II E de Lamas, San Martin,
Peru.
Paolo R. Valdez Barreto,
Departamento de Medicina Oncológica, Hospital de Alta Complección Virgen de
la Puerta, La Libertad, Peru.
Ruth Huaringa-Leiva,
Departamento de Medicina Oncológica, Hospital Militar Central, Lima, Peru.
Omar Condori Troncoso,
Departamento de Medicina Oncológica, Hospital Militar Central, Lima, Peru.
Johanny Muro-Cieza,
Departamento de Medicina Oncológica, Hospital Regional Docente de
Cajamarca, Cajamarca, Peru.
Silvia Neciosup Delgado,
Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades
Neoplásicas, Lima, 15038, Peru.
Jhajaira M. Araujo,
Escuela Profesional de Medicina Humana, Universidad Privada San Juan Bautista,
Lima, Perú.
Henry L. Gómez,
Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas,
Lima, 15038, Peru.
Please see the link here: https://stm.bookpi.org/ANUMS-V5/article/view/13394
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