Impact of COVID-19 on cancer diagnosis and management in Slovenia – preliminary results

Abstract

BackgroundThe COVID-19 pandemic has disrupted the provision and use of healthcare services throughout the world. In Slovenia, an epidemic was officially declared between mid-March and mid-May 2020. Although all non-essential health care services were put on hold by government decree, oncological services were listed as an exception. Nevertheless, as cancer control depends also on other health services and additionally major changes in people’s behaviour likely occurred, we aimed to analyse whether cancer diagnosis and management were affected during the COVID-19 epidemic in Slovenia.MethodsWe analysed routine data for the period November 2019 through May 2020 from three sources: (1) from the Slovenian Cancer Registry we analysed data on pathohistological and clinical practice cancer notifications from two major cancer centres in Ljubljana and Maribor; (2) from the e-referral system we analysed data on all referrals in Slovenia issued for oncological services, stratified by type of referral; and (3) from the administrative data of the Institute of Oncology Ljubljana we analysed data on outpatient visits by type as well as on diagnostic imaging performed.ResultsCompared to the November 2019 – February 2020 average, the decrease in April 2020 was about 43% and 29% for pathohistological and clinical cancer notifications; 33%, 46% and 85% for first, control and genetic counselling referrals; 19% (53%), 43% (72%) and 20% (21%) for first (and control) outpatient visits at the radiotherapy, surgery and medical oncology sectors at the Institute of Oncology Ljubljana, and 48%, 76%, and 42% for X-rays, mammograms and ultrasounds performed at the Institute, respectively. The number of CT and MRI scans performed was not affected.ConclusionsSignificant drops in first referrals for oncological services, first visits and imaging studies performed at the Institute, as well as cancer notifications in April 2020 point to a possibility of a delayed cancer diagnosis for some patients during the first surge of SARS-CoV-2 cases in Slovenia. The reasons for the delay cannot be ascertained with certainty and could be linked to health-seeking behaviour of the patients, the beliefs and practices of doctors and/ or the health system management during the epidemic. Drops in control referrals and control visits were expected and are most likely due to the Institute of Oncology Ljubljana postponing non-essential follow-ups through May 2020.

Impact of the COVID-19 Pandemic on Cancer Diagnoses in General and Specialized Practices in Germany

“…For example, previous research has indicated that the rate of stroke [ 11 ], acute heart failure [ 12 ], and pulmonary embolism diagnoses [ 13 ] has fallen during the COVID-19 pandemic, which may be explained by a decrease in the proportion of symptomatic patients seeking medical care. Several studies have also shown that the incidence of cancer has decreased during lockdown in a number of countries [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ]. Some cancer diagnoses might have been more affected by the COVID-19 than other cancer diagnoses, and cancers detected in the context of screening programs might have been particularly impacted.…”

“Swords and Shields” against COVID-19 for patients with cancer at “clean” and “pandemic” hospitals: are we ready for the second wave?

“…Fear and anxiety associated with COVID-19 caused the patients to delay their treatment by disrupting adherence to therapy [ 22 ]. In addition, delaying diagnostic tests was another issue during pandemic leading to the presentation of cancer patients at advanced stage [ 20 , 21 ]. Guven et al evaluated the effect of COVID-19 on admissions of cancer patients and determined that there was a significant decrease in the number of newly diagnosed cancer cases when compared with the previous year [ 19 ].…”

“…De Vincentiis et al reported that the average number of newly diagnosed cancer patients in the 2018–2019 period decreased by approximately 39% during the 2020 pandemic period [ 21 ]. Similarly, another study conducted in Slovenia showed that diagnostic-screening tests and newly diagnosed cancer patients decreased in the COVID-19 pandemic [ 20 ]. In all four experienced centers included in this study, the number of newly diagnosed patients during the pandemic process decreased significantly compared with the previous year as of in our study, in correlation to the literature.…”

Cancer treatment in the coronavirus disease pandemic

“…Prolonged clinical trial closure does not appear to be warranted. Third, early detection of cancer is crucial for secondary cancer prevention [ [72] , [73] , [74] ]. Screening for high-risk populations must be firmly implemented in accordance with the guidelines.…”