Fewer Cancer Diagnoses During COVID-19 in the Netherlands

By Carolyn Crist

May 11, 2020

NEW YORK (Reuters Health) - Cancer diagnoses have dropped in the Netherlands during the COVID-19 outbreak, which could affect subsequent treatment, a team of oncologists reports.

Healthcare providers should have "cautious optimism" that rates will increase again as countries remove shelter-in-place orders but also be vigilant about potential cases, the authors write in The Lancet Oncology.

"We all try to diagnose cancer patients as soon as possible because the details about the tumor are important in determining options for treatment and giving a dutiful prognosis," said Dr. Sabine Siesling of the Netherlands Comprehensive Cancer Organisation in Utrecht, which hosts the Netherlands Cancer Registry.

"A few weeks of delay may not influence prognosis immediately, per se, but it's important to be on top of it and note all of the side effects of having fewer cancer diagnoses," she told Reuters Health by phone.

Dr. Siesling and colleagues began monitoring the number of diagnoses each week in the country as the pandemic hit. They graphed the numbers from January 6 to April 12, which shows a dramatic dip in late February when the first COVID-19 case was confirmed in the Netherlands.

By the week of March 2, the number of cancer diagnoses (all sites excluding skin) was down to 73% of normal, while skin-cancer diagnoses (excluding basal cell carcinoma) were at 64%. The numbers then increased slightly and dropped again in mid-March after the nationwide implementation of strict social-distancing policies and a temporary halt of national cancer-screening programs.

By the end of March, skin-cancer diagnoses were at 39% and cancer diagnoses for other sites at 75%. The drop occurred in all age groups and geographic regions, the authors said.

On April 2 and April 15, the Netherlands Comprehensive Cancer Organization disseminated their findings among Dutch citizens to create awareness. They encouraged potential patients with symptoms to talk to their doctors and doctors to refer their patients. After the public-awareness campaign, rates rose slightly again.

"What we noticed is that the COVID-19 crisis influenced regular care as hospital capacity shifted to treat COVID-infected patients and facilities were used differently," Dr. Siesling said. "Then we began discussing how to overcome this decline in cancer diagnoses."

The decrease may have occurred for several reasons, the authors write. Those with non-specific cancer symptoms might face barriers to consulting their primary care doctors, including moral concerns about "wasting the general practitioner's time" with non-coronavirus symptoms, they speculate. Potential patients may also have assumed that hospitals and other healthcare facilities wouldn't have capacity for non-COVID-19 services or had concerns about acquiring COVID-19 in these healthcare settings.

In addition, as doctor's appointments shifted to telehealth options, follow-up meetings may have been postponed temporarily if the symptoms didn't immediately point to a potential cancer diagnosis. In turn, this may have led to a delay in hospital referrals. Following that, hospitals may have postponed diagnostic tests or had longer turnaround times for diagnostic evaluations after a screening.

Finally, national screening programs in the Netherlands were stopped temporarily on March 16 for breast, colorectal and cervical cancer to reduce demand on the healthcare system due to COVID-19. Ultimately, the authors write, fewer cancer diagnoses during this time will likely come from delays at all points in the process - patients, doctors and the healthcare system.

"Diagnostic delay is concerning because, in some studies, it has been associated with progression to a more advanced cancer stage and potentially increased mortality," said Dr. Timothy Hanna of the Kingston General Health Research Institute in Ontario, Canada. Dr. Hanna, who wasn't involved with this commentary, has written about cancer diagnosis during the COVID-19 outbreak and the need to prioritize treatment during a global pandemic.

"There needs to be a clear message to the public to seek help for concerns without delay and that doing so is welcomed and encouraged," Dr. Hanna told Reuters Health by email. "We must keep delays and waiting times as short as reasonably achievable." SOURCE: https://bit.ly/2yvmOTP The Lancet Oncology, online April 30, 2020