OBJECTIVES: This study aimed to compare the overall survival (OS) of patients with incident lung cancer (LC) diagnosed before and during the COVID-19 pandemic in Germany.

METHODS: Using a retrospective, anonymized German claims database, cases with an incident LC diagnosis (=index) were identified during 01/07/2018-30/06/2021. Cases were included if they had at least two confirmed outpatient diagnoses or one inpatient diagnosis of LC (ICD-10-GM code: C34). A case was considered incident if there was a diagnosis-free period of 12 months before above date. Patients were divided into two groups based on their index year (2018/2019 versus 2020/2021) and followed for 12 months or until death (if earlier). OS after incident diagnosis was calculated using Kaplan-Meier estimation and compared between the two groups within a Cox regression model considering main patient characteristics (including metastasis status at index).

RESULTS: The analysis included 4,210 incident LC patients, with 2,323 (55.2%) diagnosed in 2018/2019 (mean age: 69.2 years; male: 66.5%; Elixhauser comorbidity score [ECI]: 9.3) and 1,887 (44.8%) in 2020/2021 (mean age: 69.1 years; male: 66.6%; ECI: 8.9). In 2020/2021, a higher percentage of patients were metastasized at diagnosis (38.8% versus 2018/2019: 33.1%; p<0.001). Significantly more patients diagnosed in 2020/2021 died during the 12-month follow-up (50.2% versus 2018/2019: 46.2%; p=0.011). The median OS for patients diagnosed in 2020/2021 was 11.9 months, whereas the median was not reached for patients diagnosed in 2018/2019. Cox regression confirmed the tendency of shorter OS in patients with incident diagnosis in 2020/2021 but without statistical significance (HR: 1.05; p=0.318).

CONCLUSIONS: This analysis showed that, generally, fewer cases were diagnosed during the pandemic. However, those that were detected were more likely in an advanced stage, which was reflected in worse OS outcomes. Further research is needed to investigate the pandemic's underlying factors and impact on real-world outcomes in LC patients.