key: cord-0733987-k3sqcefy authors: Iavarone, Massimo; Antonelli, Barbara; Ierardi, Anna Maria; Topa, Matilde; Sangiovanni, Angelo; Gori, Andrea; Oggioni, Chiara; Rossi, Giorgio; Carrafiello, Gianpaolo; Lampertico, Pietro title: Reshape and secure HCC managing during COVID‐19 pandemic: A single centre analysis of four periods in 2020 versus 2019 date: 2021-10-15 journal: Liver Int DOI: 10.1111/liv.15077 sha: b1a374b1aa2054424b4ac5023ee04a617e42b022 doc_id: 733987 cord_uid: k3sqcefy The COVID-19 pandemic threatened to completely change the priorities of our health systems. However, the diagnosis and timely treatment of patients with cancer should never be compromised: the interruption or delay of cancer surveillance or treatments schedules, due to pandemic, may significantly impact patients' survival.[1] This is particularly true for HCC: despite the task of guaranteeing the safety of our patients, facing a new infection with an increased mortality risk in patients with cirrhosis, we needed to maintain treatments of HCC and in adequate timeframe.[2-4] While studies had shown how deep the pandemic has changed the management of HCC with respect to surveillance, diagnosis, and treatment, none has evaluated the effectiveness of the measures taken to cope with COVID-19. Reshape and secure HCC managing during COVID-19 pandemic: A single centre analysis of four periods in 2020 versus 2019 The COVID-19 pandemic threatened to completely change the priorities of our health systems. However, the diagnosis and timely treatment of patients with cancer should never be compromised: the interruption or delay of cancer surveillance or treatments schedules, because of pandemic, may significantly impact patients' survival. 1 This is particularly true for HCC: despite the task of guaranteeing the safety of our patients, facing a new infection with increased mortality risk in patients with cirrhosis, we needed to maintain treatments of HCC and in the adequate timeframe. [2] [3] [4] While studies had shown how deep the pandemic has changed the management of HCC with respect to surveillance, diagnosis and treatment, none has evaluated the effectiveness of the measures taken to cope with COVID-19. 1, [5] [6] [7] To evaluate the impact of new measures deployed for HCC management during the pandemic, we compared the efficiency and clinical quality key performance indicators (KPI) generated from 2020 to 2019. This is a single centre, retrospective study, including patients with HCC managed by our multidisciplinary team. To assess if the modified strategies adopted to manage HCC during the COVID-19 pandemic allowed us to maintain the standard of care, we compared selected KPI in 2020 with those generated in 2019, in patients with HCC discussed in a weekly multidisciplinary team meeting (MDTM). According to the SARS-CoV-2 incidence in Italy, four different periods were compared: the prepandemic phase (January-February), the first-wave phase (March-May), the low-incidence phase (June-September) and the second-wave phase (October-December). In our centre, treatment for each patient is decided by MDTM according to international guidelines. In 2017, we formally adopted as quality control of care the maximum acceptable timeframe for HCC management, selected on the basis of both tumour doubling time and expected survival benefit. [8] [9] [10] To face the pandemic, percutaneous microwave thermal ablation (MWTA) was preferred to surgical resection and laparoscopic MWTA to reduce both the needs of postoperative stays in the intensive care unit and the hospital stay duration. 7 We considered surgery case-by-case, whenever percutaneous ablation was judged inappropriate. Transarterial chemo(radio) embolization (TACE and TARE) was maintained whenever the risk/benefit ratio was judged appropriate. Systemic treatments were maintained as per clinical practice. Continuous variables were expressed as median and range, and categorical variables were presented as frequency and percentages. Student's t test for continuous variables and χ 2 test for categorical variables were used to compare performances in 2020 to 2019 and the four periods of the year. The first documented case of COVID-19 in our hospital occurred on 23 February 2020. Thereafter, the hospital's organization was quickly modified: specific clinical pathways for patients with COVID-19 were created and internal guidelines were implemented and periodically updated. In 2020, in our hospital, 2154 patients entered for COVID-19, with the peak in November (560 patients) and the nadir in July 2020 (20 patients). year and between each period of the 2 years under analysis ( Table 1) . Durations of the different timeframes are presented in Table 2 according to the four periods of COVID-19 pandemic. Overall, considering the whole course of a single HCC management, the median Outpatients This is the first study to evaluate the efficiency and quality of the measures implemented to tackle the challenges for HCC management owing to the SARS-CoV-2 pandemic. In general, there are a few papers addressing the measurement of quality of care in patients with cirrhosis in the field of hepatology, generally evaluating HCC surveillance only. [8] [9] [10] [11] We showed that these strategies were able to safely ensure continuity of care to our HCC patients, highlighting some negative effects in terms of procedures not performed or de- .008 20 (4-64) .007 .0009 25 (4-84) .0009 .876 .134 20 (4-64) .024 .004 .0001 20 (4-69) .042 .0006 34 (26-71) .421 33 (14-69) .0008 34 (4-77) .001 <.0001 Assessing the impact of COVID-19 on liver cancer management (CERO-19) High rates of 30-day mortality in patients with cirrhosis and COVID-19 Outcomes following SARS-CoV-2 infection in patients with chronic liver disease: an international registry study Management of hepatocellular carcinoma in the time of COVID-19 Impact of COVID-19 pandemic on surveillance of hepatocellular carcinoma: a study in patients with chronic hepatitis C after sustained virologic response Paris Liver Cancer Group. Impact of COVID-19 on the management of hepatocellular carcinoma in a high-prevalence area Changes in hepatocellular carcinoma surveillance and risk factors for noncompletion in the veterans health administration cohort During the coronavirus disease 2019 pandemic Wait time for curative intent radio frequency ablation is associated with increased mortality in patients with early stage hepatocellular carcinoma Multimodality treatment of hepatocellular carcinoma: how field practice complies with international recommendations Neoangiogenesis-related genes are hallmarks of fast-growing hepatocellular carcinomas and worst survival. Results from a prospective study An explicit quality indicator set for measurement of quality of care in patients with cirrhosis AISF COVID-19 survey group. Management of liver disease in Italy after one year of the SARS-CoV-2 pandemic: a web-based survey Reshape and secure HCC managing during COVID-19 pandemic: A single centre analysis of four periods in 2020 versus 2019