Cancer diagnosis in Catalonia (Spain) after two years of COVID-19 pandemic: an incomplete recovery

Ribes, Josepa; Pareja, Laura; Sanz, X.; Mosteiro, S; JM, Escribà; Esteban, Laura; Gálvez, Jordi; Osca, Gemma; Rodenas, Pepi; Pérez-Sust, P.; Jm, Borràs

doi:10.1016/j.esmoop.2022.100486

Cited by 12 publications

(25 citation statements)

References 71 publications

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“…[1][2][3][4][5] Although healthcare services for serious conditions, such as cancer, were mostly exempt from restriction measures, nevertheless, they were affected by the COVID-19 pandemic. [6][7][8][9][10][11][12][13][14][15][16] As previously reported for Slovenia 17 , a middle European country with a universal health care system, in the first wave of COVID-19 containment measures (from March 2020 until May 2020) there was a decrease of over 30% in the number of new cancer diagnoses, 30% in referrals to cancer care (33% for first appointments, 46% for follow-up appointments and 85% for genetic testing and counselling), 20% in the number of outpatients appointments at the Institute of Oncology Ljubljana (IOL) and 40% in the number of diagnostic imaging performed, despite the fact that provision of oncology services was included among exemptions to healthcare-related restriction measures and was thus not directly scaled-down.…”

Section: Introductionmentioning

confidence: 99%

Impact of the COVID-19 epidemic on cancer burden and cancer care in Slovenia: a follow-up study

Žagar

Tomšič

Zadnik

et al. 2022

Radiology and Oncology

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Background In Slovenia, cancer care services were exempt from government decrees for COVID-19 containment. Nevertheless, cancer control can be impacted also by access to other health services and changes in health-seeking behaviour. In this follow up study, we explored changes in cancer burden and cancer care beyond the first months after the onset of the COVID-19 epidemic. Materials and methods We analysed routinely collected data for the period January 2019 through July 2022 from three sources: (1) pathohistological and clinical practice cancer notifications from two major cancer centres in Ljubljana and Maribor (source: Slovenian Cancer Registry); (2) referrals issued for oncological services (source: e-referral system); and (3) outpatient appointments and diagnostic imaging performed (source: administrative data of the Institute of Oncology Ljubljana – IOL). Additionally, changes in certain clinical and demographic characteristics in patients diagnosed and treated during the epidemic were analysed using the Hospital-Based Cancer Registry of the IOL (period 2015–2021). Results After a drop in referrals to follow-up cancer appointments in April 2020, in June-August 2020, there was an increase in referrals, but it did not make-up for the drop in the first wave; the numbers in 2021 and 2022 were even lower than 2020. Referrals to first cancer care appointments and genetic testing and counselling increased in 2021 compared to 2019 and in 2022 increased further by more than a quarter. First and follow-up outpatient appointments and cancer diagnostic imaging at the IOL dropped after the onset of the epidemic in March 2020 but were as high as expected according to 2019 baseline already in 2021. Some deficits remain for follow-up outpatients’ appointments in surgical and radiotherapy departments. There were more CT, MRI and PET scans performed during the COVID-19 period than before. New cancer diagnoses dropped in all observed years 2020, 2021 and until July 2022 by 6%, 3% and 8%, respectively, varying substantially by cancer type. The largest drop was seen in the 50−64 age group (almost 14% in 2020 and 16% in 2021), while for patients older than 80 years, the numbers were above expected according to the 2015–2019 average (4% in 2020, 8% in 2021). Conclusions Our results show a varying effect of COVID-19 epidemic in Slovenia for different types of cancers and at different stages on the patient care pathway – it is probably a mixture of changes in health-seeking behaviour and systemic changes due to modifications in healthcare organisation on account of COVID-19. A general drop in new cancer cases reflects disruptions in the pre-diagnostic phase and could have profound long-term consequences on cancer burden indicators.

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Section: Introductionmentioning

confidence: 99%

Impact of the COVID-19 epidemic on cancer burden and cancer care in Slovenia: a follow-up study

Žagar

Tomšič

Zadnik

et al. 2022

Radiology and Oncology

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“…Similar estimates were found for each four-week delay in adjuvant and neoadjuvant systemic treatment and the risk of death (Hanna et al 2020 ). Previous studies showed a drop in screening rates (Chen et al 2021 ; Dinmohamed et al 2020 ; Teglia et al 2022 ), cancer reporting by pathology departments (Johansson et al 2022 ; Peacock et al 2021 ; Ribes et al 2022 ; Stang et al 2020 ) as well as the number of patients with newly identified cancer (Angelini et al 2023 ; Coma et al 2021 ; Epidemiologisches Krebsregister Baden-Württemberg 2022 ; Kaufman et al 2021 ; Morris et al 2021 ; Voigtländer et al 2021 ), and a delay of non-urgent/elective surgery (Bakouny et al 2020 ) during the COVID-19 pandemic. Significant reductions observed for all major tumor sites including breast, prostate, colorectum, and lung (Chen et al 2021 ; Coma et al 2021 ; Johansson et al 2022 ; Kaufman et al 2021 ; Morris et al 2021 ; Peacock et al 2021 ; Ribes et al 2022 ) were larger in the first COVID-19 wave around April and May 2020 compared to the second COVID-19 wave around November 2020, December 2020, and January 2021 (Coma et al 2021 ; Johansson et al 2022 ; Kaufman et al 2021 ; Peacock et al 2021 ; Ribes et al 2022 ).…”

Section: Introductionmentioning

confidence: 97%

“…Previous studies showed a drop in screening rates (Chen et al 2021 ; Dinmohamed et al 2020 ; Teglia et al 2022 ), cancer reporting by pathology departments (Johansson et al 2022 ; Peacock et al 2021 ; Ribes et al 2022 ; Stang et al 2020 ) as well as the number of patients with newly identified cancer (Angelini et al 2023 ; Coma et al 2021 ; Epidemiologisches Krebsregister Baden-Württemberg 2022 ; Kaufman et al 2021 ; Morris et al 2021 ; Voigtländer et al 2021 ), and a delay of non-urgent/elective surgery (Bakouny et al 2020 ) during the COVID-19 pandemic. Significant reductions observed for all major tumor sites including breast, prostate, colorectum, and lung (Chen et al 2021 ; Coma et al 2021 ; Johansson et al 2022 ; Kaufman et al 2021 ; Morris et al 2021 ; Peacock et al 2021 ; Ribes et al 2022 ) were larger in the first COVID-19 wave around April and May 2020 compared to the second COVID-19 wave around November 2020, December 2020, and January 2021 (Coma et al 2021 ; Johansson et al 2022 ; Kaufman et al 2021 ; Peacock et al 2021 ; Ribes et al 2022 ). Between the first and the second COVID-19 wave the number of patients diagnosed with cancer recovered, but did—in most countries—not reach pre-pandemic levels (Coma et al 2021 ; Johansson et al 2022 ; Kaufman et al 2021 ; Morris et al 2021 ; Peacock et al 2021 ; Ribes et al 2022 ; Voigtländer et al 2021 ), so that many cancers may remain undiagnosed for a longer period of time (Kaufman et al 2021 ).…”

Section: Introductionmentioning

confidence: 97%

“…Significant reductions observed for all major tumor sites including breast, prostate, colorectum, and lung (Chen et al 2021 ; Coma et al 2021 ; Johansson et al 2022 ; Kaufman et al 2021 ; Morris et al 2021 ; Peacock et al 2021 ; Ribes et al 2022 ) were larger in the first COVID-19 wave around April and May 2020 compared to the second COVID-19 wave around November 2020, December 2020, and January 2021 (Coma et al 2021 ; Johansson et al 2022 ; Kaufman et al 2021 ; Peacock et al 2021 ; Ribes et al 2022 ). Between the first and the second COVID-19 wave the number of patients diagnosed with cancer recovered, but did—in most countries—not reach pre-pandemic levels (Coma et al 2021 ; Johansson et al 2022 ; Kaufman et al 2021 ; Morris et al 2021 ; Peacock et al 2021 ; Ribes et al 2022 ; Voigtländer et al 2021 ), so that many cancers may remain undiagnosed for a longer period of time (Kaufman et al 2021 ).…”

Section: Introductionmentioning

confidence: 99%

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Impact of the COVID-19 pandemic on reported cancer diagnoses in Bavaria, Germany

Voigtländer¹,

Hakimhashemi²,

Grundmann³

et al. 2023

J Cancer Res Clin Oncol

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Purpose The aim of our study was to explore the impact of the COVID-19 pandemic on reported cancer cases in Bavaria, Germany, by comparing pre-pandemic (March 2019 to February 2020) and pandemic period (March 2020 to February 2021). Methods Data on incident cases were retrieved from the Bavarian Cancer Registry (until 22nd April 2022). We included patients with malignant and in situ neoplasms reported by pathology departments with consistent reporting. We calculated the number of incident cases during the COVID-19 pandemic and the pre-pandemic period with 95% confidence intervals (CI) with Bonferroni correction (α = 0.0018) based on a Poisson approach. We stratified for malignancy (malignant, in situ), tumor site, and month of year. Results Data was available for 30 out of 58 pathology departments (51.7%) from Bavaria. Incident malignant neoplasms dropped from 42,857 cases in the pre-pandemic period to 39,980 cases in the pandemic period (− 6.7%; 95% CI − 8.7%, − 4.7%). Reductions were higher for colon, rectum, skin/melanoma as well as liver (> 10.0% reduction) and less for breast cancer (4.9% reduction). No case reductions were observed for pancreas, esophagus, ovary, and cervix. Percent changes were largest for April 2020 (− 20.9%; 95% CI − 24.7%, − 16.8%) and January 2021 (− 25.2%; 95% CI − 28.8%, − 21.5%) compared to the previous year. Declines tended to be larger for in situ compared to malignant neoplasms. Conclusion Detection and diagnosis of cancer were substantially reduced during the COVID-19 pandemic. Potential effects, e.g. a stage shift of tumors or an increase of cancer mortality, need to be monitored.

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“…The first COVID-19 pandemic wave severely affected Spain during the Spring of 2020 and a state of emergency was declared with a severe nationwide lockdown exerted from March to June 2020. The sanitary system was shocked and, despite telemedicine being expanded and cancer treatment protocols being optimized, hospital-based studies have uniformly confirmed a decrease in cancer diagnosis of 21–37% in the first wave [ 6 , 7 , 8 , 9 , 10 ], which leveled off at 17% in the first pandemic year [ 11 ] and 12% after two years [ 12 ]. Channeling health resources to COVID-19 patient care required cancelling or postponing many non-COVID-19-related care activities including cancer screening programs, imaging services, interventions and histopathologic evaluations.…”

Section: Introductionmentioning

confidence: 99%

Impact of the COVID-19 Pandemic on Cancer Diagnosis in Madrid (Spain) Based on the RTMAD Tumor Registry (2019–2021)

Garrido-Cantero

Longo

Hernández-González

et al. 2023

Cancers

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The coronavirus disease 2019 (COVID-19) pandemic has caused a significant disruption to cancer diagnosis, treatment and prevention worldwide that could have serious consequences in the near future. We intend to evaluate the weight of this backlog on a community-wide scale in Madrid during the period 2020–2021, and whether a stage shift towards the advanced stage has occurred. Cancer diagnoses in the Madrid tumor registry (RTMAD) from 2019–2021 were evaluated. Absolute and percentage differences in annual volume and observed-to-expected (O/E) volume ratios were calculated. Standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) were calculated using the O/E ratio. The SIR for 2020–2021 compared to 2019 was 94.5% (95% CI 93.8–95.3), with unequal gender-specific cancer diagnosis recovery (88.5% for males and 102.1% for females). Most cancer types were underdiagnosed in 2020. The tendency worsened in 2021 for colorectal and prostate cancers (87.8%), but lung cancer recovered (102.1%) and breast cancer was over-diagnosed (114.4%) compared with reference pre-COVID-19 data. These changes have modified the ranking of the most frequent malignancies diagnosed in Madrid. Breast cancer has overtaken colorectal and prostate cancers, displaced to second and third position, respectively. Not only was colorectal cancer diagnosis affected more as a consequence of the COVID-19 pandemic but diagnosis of this malignancy at the advance stage also increased by 3.6% in 2020 and 4.2% in 2021 compared to the reference period of 2019. In summary, there is a large volume of undetected cancer in Madrid caused by the reduced access to care secondary to the COVID-19 pandemic, especially regarding colorectal and prostate cancer. Strategies are needed to recover the backlog of diagnoses and effectively treat these cases in the future and solve the negative impact that will be caused by the diagnostic delay. Analyzing the impact of new diagnoses suffered by each different malignancy and their recovery will help to understand how the future allocation of resources should look.

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Cancer diagnosis in Catalonia (Spain) after two years of COVID-19 pandemic: an incomplete recovery

Cited by 12 publications

References 71 publications

Impact of the COVID-19 epidemic on cancer burden and cancer care in Slovenia: a follow-up study

Impact of the COVID-19 epidemic on cancer burden and cancer care in Slovenia: a follow-up study

Impact of the COVID-19 pandemic on reported cancer diagnoses in Bavaria, Germany

Impact of the COVID-19 Pandemic on Cancer Diagnosis in Madrid (Spain) Based on the RTMAD Tumor Registry (2019–2021)

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