The impact of the COVID-19 pandemic on cervical cancer disease severity

Background: The COVID-19 (C19) pandemic is reported to be associated with decreases in cervical cancer screening, diagnostic procedures, number of patients receiving treatment, and treatment delays/interruptions, leading to increased disease progression compared to pre-C19. This study aims to investigate if an increase in squamous cell cervical cancer (SCCC) disease severity occurred and evaluate changes in time to treatment during C19. Methods: This retrospective study analyzed the National Cancer Database from 2018–2019 (pre-C19) and 2020–2021 (C19) for patients with SCCC. Descriptive statistics were utilized to compare American Joint Committee on Cancer (AJCC) tumor node metastasis (TNM) stage distribution (correlating with 2018 International Federation of Gynecology and Obstetrics (FIGO) IA1–IVB), time from diagnosis to treatment, and treatment types received between pre-C19 and C19. Results: A total of 11,455 SCCC patients pre-C19 were compared to 10,155 during C19. During C19, there were fewer patients with early-stage disease (FIGO IA1–IIA2) (44.1% pre-C19 vs. 38.1% C19), more with locally advanced disease (FIGO IIB–IVA) (42.8% pre-C19 vs. 47.8% C19), and more with metastatic disease (FIGO IVB) (13.0% pre-C19 vs. 14.1% C19) (p < 0.001). Time to treatment (p = 0.10) and surgery (p = 0.29) did not differ significantly. There were significantly fewer surgeries during C19 (34.1% pre-C19 vs. 31.8% C19, p < 0.001). There was no statistical difference in age (p = 0.12), Charlson Comorbidity Index scores (p = 0.23), receipt of chemotherapy (68.8% pre-C19 vs. 69.9% C19, p = 0.09), or radiation (29.9% pre-C19 vs. 28.8% C19, p = 0.10) during C19. Conclusions: Despite no significant differences in time to treatment and surgery, there was a higher incidence of more advanced SCCC during the C19 pandemic. This may be explained by decreased routine examination and diagnostic follow-up. Further data are awaited to characterize the long-term survival effects of C19 on SCCC patients.