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COVID-19 and liver cancer: Lost patients and larger tumours

Lookup NU author(s): Dr Daniel Geh, Robyn Watson, Gourab Sen, Jeremy French, John Hammond, Professor Stuart McPhersonORCiD, Dr Steven MassonORCiD, Dr Jess Dyson, Professor Quentin AnsteeORCiD, Steven White, Sanjay PandanaboyanaORCiD, Misti McCainORCiD, Dr Yvonne BuryORCiD, Dr Beate Haugk, Dr Antony Darne, Dr Nicholas Wadd, Dr Jane Margetts, Dr Peter Littler, Professor Derek Manas, Professor Helen ReevesORCiD



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© Author(s) (or their employer(s)) 2022.Background Northern England has been experiencing a persistent rise in the number of primary liver cancers, largely driven by an increasing incidence of hepatocellular carcinoma (HCC) secondary to alcohol-related liver disease and non-alcoholic fatty liver disease. Here we review the effect of the COVID-19 pandemic on primary liver cancer services and patients in our region. Objective To assess the impact of the COVID-19 pandemic on patients with newly diagnosed liver cancer in our region. Design We prospectively audited our service for the first year of the pandemic (March 2020-February 2021), comparing mode of presentation, disease stage, treatments and outcomes to a retrospective observational consecutive cohort immediately prepandemic (March 2019-February 2020). Results We observed a marked decrease in HCC referrals compared with previous years, falling from 190 confirmed new cases to 120 (37%). Symptomatic became the the most common mode of presentation, with fewer tumours detected by surveillance or incidentally (% surveillance/incidental/symptomatic; 34/42/24 prepandemic vs 27/33/40 in the pandemic, p=0.013). HCC tumour size was larger in the pandemic year (60±4.6 mm vs 48±2.6 mm, p=0.017), with a higher incidence of spontaneous tumour haemorrhage. The number of new cases of intrahepatic cholangiocarcinoma (ICC) fell only slightly, with symptomatic presentation typical. Patients received treatment appropriate for their cancer stage, with waiting times shorter for patients with HCC and unchanged for patients with ICC. Survival was associated with stage both before and during the pandemic. 9% acquired COVID-19 infection. Conclusion The pandemic-associated reduction in referred patients in our region was attributed to the disruption of routine healthcare. For those referred, treatments and survival were appropriate for their stage at presentation. Non-referred or missing patients are expected to present with more advanced disease, with poorer outcomes. While protective measures are necessary during the pandemic, we recommend routine healthcare services continue, with patients encouraged to engage.

Publication metadata

Author(s): Geh D, Watson R, Sen G, French JJ, Hammond J, Turner P, Hoare T, Anderson K, Mcneil M, Mcpherson S, Masson S, Dyson J, Donnelly M, Macdougal L, Patel P, Hudson M, Anstee QM, White S, Robinson S, Pandanaboyana S, Walker L, Mccain M, Bury Y, Raman S, Burt A, Parkinson D, Haugk B, Darne A, Wadd N, Asghar S, Mariappan L, Margetts J, Stenberg B, Scott J, Littler P, Manas DM, Reeves HL

Publication type: Article

Publication status: Published

Journal: BMJ Open Gastroenterology

Year: 2022

Volume: 9

Issue: 1

Print publication date: 21/04/2022

Online publication date: 21/04/2022

Acceptance date: 27/03/2022

Date deposited: 19/01/2023

ISSN (electronic): 2054-4774

Publisher: BMJ Publishing Group


DOI: 10.1136/bmjgast-2021-000794


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Funder referenceFunder name
Newcastle CR UK Clinical Academic Training Programme
Newcastle upon Tyne Hospitals NHS Foundation Trust
Newcastle National Institute for Health Research Biomedical Research Centre