In the Region with the highest incidence rate among men nationwide (112 cases per 100 thousand inhabitants) of lung cancer, a high serious effect of the pandemic is becoming visible: precisely in Campania – where approximately 4,100 new cases are recorded every year – in fact, an increase of 30% in the diagnosis of advanced stage lung cancer is estimated. A frightening scenario that has led experts to ask that, as is already the case in other countries, free screening with low-dose spiral CT scan for heavy smokers is introduced, in order to increase early diagnosis and the possibility of survival.
The effects of the pandemic
“Already in recent months – he clarifies Cesare Gridelli, director of Onco-Hematology Hospital ‘Moscati’ Avellino – we have been able to observe an increase in advanced diagnoses of lung cancer, attributable to the reduced hospital access of patients under treatment or who accused suspected symptoms, for fear of contagion. An outcome that could have been avoided in Campania, which, in line with the Regional Decree, has never suspended the treatment of cancer ”.
Surgery is on the rise
“In my reference structure, as in the others in the Region, therapeutic continuity has always been guaranteed – he explains Carlo Curcio, director of the Complex Operative Unit of Thoracic Surgery at the Colli Monaldi Hospital in Naples – but fear has slowed down both new visits and checks for patients with localized neoplasms. The risk is that diagnoses of advanced lung cancer will increase by 30%, with negative consequences in terms of prognosis. On the other hand, however, it should be emphasized that this year we recorded an increase in surgical interventions, for a total of 638, compared to 610 in 2019. The availability of a greater number of accesses in the operating rooms, free for postponement of the interventions that can be postponed, made it possible to dispose of the waiting lists, for the benefit of cancer patients already candidates for surgery “.
The damages of 2020 vs those of 2021
On the other hand, the patients who received the new diagnosis of pulmonary neoplasia in the period from March to December 2020 suffered the greatest damage from the pandemic. “Pulmonologists – continues Curcio – have been involved in the front line management of the Covid emergency and this has hindered the multidisciplinary evaluation, essential for defining the therapeutic approach in a neoplasm that is very difficult to treat such as lung cancer. A situation that has seen an important improvement starting from January 2021, with the activity of multidisciplinary groups, including the GOM lung Azienda dei Colli, and the GOM lung Moscati Avellino, of which I belong ”.
Heavy smoking screening
“It is essential – explains Gridelli – to run for cover immediately and give great impetus to screening, which should also include low-dose chest CT scan for people at risk, that is, for heavy smokers over 50. Unfortunately, this type of screening does not it is still foreseen in Italy and in other European countries, as is the case for mammography, the test for the detection of occult blood in the faeces and the Pap test. Screening, in a country where it has been adopted for some time like the United States, has proved to be indispensable for the early diagnosis of non-small cell lung cancer, a neoplasm which, if identified at an early stage, can be operated on with the possibility of healing and, in the third inoperable stage, can have good results, thanks to immunotherapy, as emerged from the important results of the Phase III Pacific study, recently presented to the Congress of the American Society of Clinical Oncology ”.
The Pacific studio
The long-term benefits of immunotherapy in locally advanced non-small cell lung cancer were illustrated. Specifically, there was a five-year overall survival rate of 42.9% for patients treated with durvalumab compared with 33.4% with no treatment after chemo-radiotherapy. After treatment for up to one year, 33.1% of durvalumab-treated patients did not progress five years after enrollment compared with 19% for placebo. “A decisive study – concludes Gridelli – which showed how, after chemo-radiotherapy treatment, maintenance for one year with durvalumab, in patients with tumor positivity of the PD-L1 receptor, and who have shown regression or stability of the disease, determines a 28% reduction in the risk of death. In light of these results, it is essential to increase the diagnostic and characterization appropriateness of PD-L1, so that more and more patients are candidates for this treatment “.
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