Assessing the impact of COVID-19 on liver cancer management (CERO-19)

Sergio Munoz-Martinez, Victor Sapena, Alejandro Forner, Jean-Charles Nault, Gonzalo Sapisochin, Lorenza Rimassa, Bruno Sangro, Jordi Bruix, Marco Sanduzzi-Zamparelli, Waclaw Holowko, Mohamed El Kassas, Tudor Mocan, Mohamed Bouattour, Philippe Merle, Frederik J. H. Hoogwater, Saleh A. Alqahtani, Helen L. Reeves, David J. Pinato, Emmanouil Giorgakis, Tim MeyerGerda Elisabeth Villadsen, Henning Wege, Massimiliano Salati, Beatriz Minguez, Giovan Giuseppe Di Costanzo, Christoph Roderburg, Frank Tacke, Maria Varela, Peter R. Galle, Mario Reis Alvares-da-Silva, Joerg Trojan, John Bridgewater, Giuseppe Cabibbo, Christian Toso, Anja Lachenmayer, Andrea Casadei-Gardini, Hidenori Toyoda, Tom Luedde, Rosanna Villani, Ana Maria Matilla Pena, Cassia Regina Guedes Leal, Monica Ronzoni, Manuel Delgado, Christie Perello, Sonia Pascual, Jose Luis Lledo, Josepmaria Argemi, Bristi Basu, Leonardo da Fonseca, Juan Acevedo

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    Background & Aims: The coronavirus disease 2019 (COVID-19) pandemic has posed unprecedented challenges to healthcare systems and it may have heavily impacted patients with liver cancer (LC). Herein, we evaluated whether the schedule of LC screening or procedures has been interrupted or delayed because of the COVID-19 pandemic.

    Methods: An international survey evaluated the impact of the COVID-19 pandemic on clinical practice and clinical trials from March 2020 to June 2020, as the first phase of a multicentre, international, and observational project. The focus was on patients with hepatocellular carcinoma or intrahepatic cholangiocarcinoma, cared for around the world during the first COVID-19 pandemic wave.

    Results: Ninety-one centres expressed interest to participate and 76 were included in the analysis, from Europe, South America, North America, Asia, and Africa (73.7%,17.1%, 5.3%, 2.6%, and 1.3% per continent, respectively). Eighty-seven percent of the centres modified their clinical practice: 40.8% the diagnostic procedures, 80.9% the screening programme, 50% cancelled curative and/or palliative treatments for LC, and 41.7% modified the liver transplantation programme. Forty-five out of 69 (65.2%) centres in which clinical trials were running modified their treatments in that setting, but 58.1% were able to recruit new patients. The phone call service was modified in 51.4% of centres which had this service before the COVID-19 pandemic (n = 19/37).

    Conclusions: The first wave of the COVID-19 pandemic had a tremendous impact on the routine care of patients with liver cancer. Modifications in screening, diagnostic, and treatment algorithms may have significantly impaired the outcome of patients. Ongoing data collection and future analyses will report the benefits and disadvantages of the strategies implemented, aiding future decision-making.

    Lay summary: The coronavirus disease 2019 (COVID-19) pandemic has posed unprecedented challenges to healthcare systems globally. Herein, we assessed the impact of the first wave pandemic on patients with liver cancer and found that routine care for these patients has been majorly disrupted, which could have a significant impact on outcomes. (C) 2021 The Authors. Published by Elsevier B.V. on behalf of European Association for the Study of the Liver (EASL).

    Original languageEnglish
    Article number100260
    Number of pages7
    JournalJHEP reports : innovation in hepatology
    Issue number3
    Publication statusPublished - Jun-2021


    • COVID-19
    • Hepatocellular carcinoma
    • Cholangiocarcinoma
    • Liver cancer
    • Management
    • Clinical trials
    • Nurses

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