Impact of COVID-19 control on lung, breast, and colorectal pathological cancer diagnoses. A comparison between the Netherlands, Aotearoa New Zealand, and Northern Ireland

Abstract

Background The COVID-19 pandemic was managed in Aotearoa New Zealand (NZ) by a COVID-19 elimination policy, involving border closure and an initial national lockdown. This was different to most other countries including Northern Ireland (NI) and the Netherlands (NED). We quantify the effect of these policies on the diagnosis of three major cancers, comparing NZ with these two European countries. Method Data from NED, NZ and NI population-based cancer registries were used to assess trends in all pathologically diagnosed (PD) lung, breast, and colorectal cancers from March to December 2020 (pandemic period) and compared to the similar pre-pandemic period (2017–2019). Trend data were also collated on COVID-19 cases and deaths per 100,000 in each population. Results Comparing the pre-pandemic period to the pandemic period there were statistically significant reductions in numbers of lung (↓23%) and colorectal (↓15%) PD cancers in NI and numbers of breast (↓18%) and colorectal cancer (↓18.5%) diagnosed in the NED. In NZ there was no significant change in the number of lung (↑10%) or breast cancers (↑0.2%) but a statistically significant increase in numbers of colorectal cancer diagnosed (↑5%). Conclusion The impact of COVID-19 on cancer services was mitigated in NZ as services continued as usual reflecting minimal healthcare disruption and protected cancer services linked with the elimination approach adopted. The reduction in PD cases diagnosed in NED and NI were linked with higher COVID-19 rates and reflect societal restrictions which resulted in delayed patient presentation to primary and secondary care, disruption to screening and healthcare services as a result of COVID-19 infections on staff and the need to shift intensive care to COVID-19 patients. Reductions in PD cancers in NI and the NED and in particularly lung cancers in NI, highlight the need for targeted public health campaigns to identify and treat ‘missing’ patients. Protecting cancer services should be a priority in any future pandemic or systemic healthcare system disruption.

Impact of COVID‐19 on cancer incidence, presentation, diagnosis, treatment and survival in Northern Ireland

“…7,8 A recent study found reduced lung, breast and colorectal pathology-confirmed cancers in Northern Ireland and the Netherlands compared to Aotearoa/New Zealand, which reflect differences in disruptions to screening and healthcare services, patient presentations to primary and secondary care and wider societal restrictions. 21 While studies have examined parts of the cancer patient pathway, we are not aware of a population-based study which examines the impact of the COVID-19 pandemic on the entire cancer patient pathway, from presentation to diagnosis through to treatment and finally to survival. Our study utilises pre-pandemic and inter-pandemic data to describe changes in finalised cancer registrations in Northern Ireland, to assess changes by demographic (age, sex) and socioeconomic (deprivation) characteristics, to investigate differences in mode of presentation, basis of diagnosis and stage distribution at diagnosis, to examine changes in treatments received and differences in overall and net survival 1-year following diagnosis.…”