Impact of COVID19 on clinical outcomes in hepatocellular carcinoma:A multicentre cohort study

Introduction: The COVID-19 pandemic has caused severe disruption of healthcare services worldwide and interrupted patients’ access to essential services. During the first lockdown, many healthcare services were shut to all but emergencies. In this study, we aimed to determine the immediate and long-term indirect impact of COVID-19 health services utilisation on hepatocellular cancer (HCC) outcomes. Methods A prospective cohort study was conducted from March 1, 2020, until June 30, 2020 correlating to the first wave of the COVID-19 pandemic. Patients were enrolled from tertiary hospitals in the UK and Germany with dedicated HCC management services. All patients with current or past HCC who were discussed at a multidisciplinary meeting (MDM) were identified. Any delay to treatment (DTT) and the effect on survival at 1 year were reported. Results The median time to receipt of therapy following MDM discussion was 49 days. Patients with Barcelona Clinic Liver Cancer (BCLC) stages-A/B disease were more likely to experience DTT. Significant delays across all treatments for HCC were observed but delay was most marked for those undergoing curative therapies. Even though severe delays were observed in curative HCC treatments, this did not translate in reduced survival in patients. Conclusion Interruption of routine healthcare services because of the COVID-19 pandemic caused severe delays in HCC treatment. However, DTT did not translate to reduced survival. Longer follow is important given the delay to therapy in those receiving curative therapy.