The study used SEER 17 registry data on 133,306 US adults with microscopically confirmed lung adenocarcinoma, diagnosed 2018–2023. Stage IV disease was 47.9% in 2020–2021 versus 47.4% in 2018–2019 (adjusted OR 1.03). Treatment delay over 90 days rose from 10.2% to 11.1%, and to 14.5% in 2022–2023 (OR 1.45). A gradient boosting model trained on 2018–2021 diagnosis-time data predicted 12-month death in 2022 (ROC AUC 0.840). The model flagged 81.6% of patients who died, against 75.4% when all stage IV patients were classed as high risk. Validation was within SEER only, which lacks performance status, smoking history, comorbidity and molecular markers.
Why it is interesting: Stage shifts during the pandemic were small, but delays to treatment grew and persisted after the acute phase. Against a stage IV rule, the model flagged 28 more patients per 1000; 21 of them died within a year.
Abstract — the authors' own words, CC BY
Background/Objectives : The COVID-19 pandemic coincided with widespread disruption of cancer care. We examined changes in lung adenocarcinoma presentation and outcomes across the COVID-19 era and whether diagnosis-time information identifies patients at risk of early death. Methods : Adults with microscopically confirmed lung adenocarcinoma diagnosed during 2018-2023 were identified from the Surveillance, Epidemiology, and End Results 17 Registries database and grouped into three diagnostic periods. Logistic regression, time-varying Cox, and Fine-Gray models evaluated stage, metastasis, surgery, delay, and mortality. Four machine-learning algorithms using only diagnosis-time variables were developed (2018-2021; n = 87,281) and temporally validated (2022; n = 22,012). Results : Among 133,306 patients, COVID-19 versus pre-COVID-19 differences were significant but small in absolute terms: stage IV disease 47.9% versus 47.4% (adjusted odds ratio [OR], 1.03; 95% CI, 1.00-1.06), organ-specific metastasis 45.8% versus 44.4% (OR, 1.06; 1.04-1.09), and treatment delay exceeding 90 days 11.1% versus 10.2% (OR, 1.11; 1.06-1.17). Post-COVID-19 (2022-2023) diagnosis showed less advanced disease but substantially longer delay (14.5% versus 10.2%; OR, 1.45; 1.39-1.52). Gradient boosting achieved a 2022 ROC AUC of 0.840 (0.834-0.845); it flagged 46.8% of patients and correctly flagged 81.6% of those who died, against 44.0% and 75.4% for stage IV classification. Conclusions : COVID-era changes in stage and metastatic presentation were small in absolute terms, whereas the increase in treatment delay was larger and persisted. A diagnosis-time model modestly improved identification of early death beyond stage alone, flagging 28 more patients per 1000, of whom 21 died within the year. These findings support further evaluation; external validation is required before clinical use.
Cite this item
BibTeX
Free sign-up. A digest of the new papers twice a week, grouped by domain.
Other drivers in Health today
-
Cancer
Where is cancer incidence rising and falling, what screening and new tests find earlier, and what treatment has done to survival.
13 this week -
Obesity, diabetes and GLP-1
Are obesity and diabetes still rising, what behavioural change and public policy do, and what difference do GLP-1s and other similar drugs make.
11 this week -
Heart and stroke
Whether deaths from heart disease and stroke have stopped falling, what is found earlier, what treatment and prevention do now, and what the deaths say.
6 this week -
Mental health
Deaths by suicide, the life expectancy gap in severe mental illness, and the physical disease that follows it: what mental illness costs in lives.
6 this week -
Dementia
Whether dementia is becoming more or less common, what is now found, what treatment and prevention do, and what the deaths say.
6 this week -
Frailty and multimorbidity
Whether the years added after 85 are healthy ones, how frailty and multiple conditions are measured, and where the data run out.
1 this week
