Impact of COVID-19 pandemic on treatment patterns for stage I Non-Small Cell Lung Cancer in the Netherlands

The COVID-19 pandemic significantly impacted lung cancer treatment, necessitating shifts in treatment modalities. Guidelines temporarily recommended SBRT as alternative to surgery for early-stage NSCLC.

This retrospective cohort study analyzed data from the Dutch Lung Cancer Audit - Radiotherapy (DLCA-R) and Surgery (DLCA-S) registries, including patients with Stage I NSCLC treated between 2018 and 2022. Patients were categorized into historic, pandemic, and post-pandemic cohorts. The primary endpoint was the percentage of surgical and radiotherapy treatments in these cohorts; secondary endpoints included time to treatment, complications, acute toxicity, and mortality.

A total of 15,072 treatment episodes were analyzed. During the pandemic, the percentage of patients with Stage I NSCLC receiving radiotherapy increased significantly from 57 % to 65 %, while the percentage of patients undergoing surgery decreased. The shift towards radiotherapy persisted post-pandemic. Time to treatment and complication rates remained stable, though pulmonary embolism rates increased during the pandemic.

The pandemic led to a significant increase in radiotherapy for Stage I NSCLC, aligning with prevailing ESMO guidelines. However, this shift persisted post-pandemic when surgical capacity was restored. Short-term outcomes were unchanged.