Real-World Data From India on Delays and Disruptions in Cervical Cancer Care Services During the COVID-19 Pandemic.

Abstract

The COVID-19 pandemic caused major disruptions in cancer diagnosis and treatment in India. This retrospective two-center study evaluated delays in cervical cancer care during the pandemic and their impact on treatment outcomes. Records of newly diagnosed patients with cervical cancer registered between March 2020 and December 2021 were reviewed. Patients were considered in the delay group if they had: more than 3 months between symptom onset and diagnosis, over 6 weeks from diagnosis to treatment initiation, or over four consecutive days of radiotherapy interruption. Causes of delays, stage migration, and treatment impact were analyzed. Survival was assessed using the Kaplan-Meier method and compared with the log-rank test. Of the 418 patients, 268 (64.1%) experienced delays. Diagnostic delay occurred in 220 (52.6%), treatment initiation delay in 126 (30.1%), and radiotherapy interruption in 84 (20%). Logistic issues accounted for most delays (54%), whereas COVID-19 infection caused 7.6%. Upward stage migration occurred in 22% of the delay group versus 11.3% without delays (<i>P</i> = .004). Definitive radiotherapy with brachytherapy was the most common treatment (63.8%). The median follow-up was 37 months. The overall survival at 1, 2, and 3 years was 75%, 58%, and 52% in the delay group versus 92%, 87%, and 84% without delays (<i>P</i> < .001). Progression-free survival at 1, 2, and 3 years was 65%, 54%, and 46% in the delay group versus 91%, 86%, and 79% without delays (<i>P</i> < .001). Survival differences remained statistically significant on multivariable analysis. Delays in cervical cancer care during the pandemic led to higher stage at diagnosis and poorer survival outcomes. These findings underscore the need for strategies to optimize resources and reduce delays in future health crises.