Cancer Diagnoses in Young People Hit by COVID-19 Pandemic

Liam Davenport

November 12, 2021

The diagnosis of childhood, teenage and young adult (CTYA) cancers was disrupted during the first wave of the COVID-19 pandemic, with large reductions in diagnoses and an increase in intensive care admissions, suggests a UK data analysis.

“We already know that the COVID-19 pandemic led to worrying delays in diagnosis and treatment for many adults with cancer, so we wanted to understand how the pandemic affected children’s cancer services,” said study presenter Dr Defne Saatci, a DPhil student at the University of Oxford, UK, in a press release.

The researchers compared over 350 CTYA diagnoses during the first wave of the pandemic with more than 2200 in the previous three years, finding that, overall, the number of diagnoses was 17% lower.

The most notable decreases were for tumours of the central nervous system (CNS), at almost -40%, and lymphoma, at nearly -30%.

The research, presented at the 2021 NRCI Festival on November 11, also indicated that childhood cancer patients diagnosed during the pandemic were more than twice as likely to have an intensive care admission than those diagnosed previously.

“A possible explanation is that these children waited longer to see a doctor, and therefore may have been more unwell at the time of their diagnosis,” said lead researcher Julia Hippisley-Cox, professor of clinical epidemiology & general practice, University of Oxford, UK.

“Together with the lower numbers of cancer diagnoses in the first wave, this study suggests COVID-19 may have had a serious impact on early diagnosis in this group of patients.

“As we recover from the pandemic, it’s vital that we get diagnosis of cancer in children and young people back on track as quickly as possible.”

Professor Hippisley-Cox told Medscape News UK that the concern is that the reduction in diagnoses during the first wave of the pandemic “may subsequently result in a potential rise in children, teenagers and young adults presenting with an underlying diagnosis of cancer that requires treatment.”

“Accordingly, the priority for children and their families is to seek medical advice early,” she said. “For clinicians and policy makers, the priority is to prepare services for a potential rise in the diagnoses of children and young adults with cancer during the current recovery phase of the pandemic.”

Speaking to Medscape News UK, Dr Sheona Scales, paediatric lead at Cancer Research UK, said: “The pandemic did really impact healthcare systems as a whole, and we estimate that, across all diagnoses, far fewer patients started their treatment.”

“What this study shows, for the first time, is concerning, but obviously important evidence around the impact of COVID-19 on these diagnoses of cancer in children and young people.”

Referring to the high rate of intensive care admissions, Dr Scales added: “We know that early diagnosis is really important for cancer outcomes, and so any delay in diagnosis can have an impact on patients.”

For the study, the team examined data from the nationally representative QResearch general primary care database to assess diagnoses of CNS tumours, lymphoma, leukaemia, sarcoma and renal tumours in CTYA individuals.

These were linked to hospital admission, mortality and cancer registry data. Incident cancer diagnoses between 1 February and 15 August 2020 were compared with those of the three preceding pre-pandemic years.

Professor Hippisley-Cox explained they chose these diagnoses as they were “only able to focus cancers we had sufficient numbers to carry out analyses on”.

In all, 2607 CTYA cancers were diagnosed between 1 January 2017 and 15 August 2020, of which 380 were identified during the COVID-19 pandemic.

There was, overall, a 17% reduction in the incidence rate ratio of CTYA cancers between the pandemic and earlier years. The largest decreases in diagnoses were seen for CNS tumours, at -38%, and lymphoma, at -28%.

Compared with previous years, childhood cancers diagnosed during the pandemic were significantly more likely to have intensive care unit admissions, at an adjusted odds ratio of 2.2 (95% CI 1.33 to 3.47).

The median time to diagnosis was not significantly longer during the pandemic than in previous years, with an average increase of 4.5 days.

However, the median time to treatment was significantly shorter during the pandemic, at an average reduction of 0.7 days (95% CI -1.1 to -0.3].

Professor Hippisley-Cox said they could not identify a reason for this reduction.

However, she underlined: “It is important to note that the median time to treatment was shorter only by 0.7 days, which is statistically significant but may not be clinically significant.”

Pamela Kearns, a member of the NCRI Children’s Group and professor of clinical paediatric oncology at the University of Birmingham, UK, who was not involved with the study, commented in the press release that “we need to better understand the reasons” why the COVID-19 pandemic had such an impact on the diagnostic pathway for CTYA cancers, “which will be multi-factorial”.

Professor Kearns added: “There are good treatments available for the majority of children and young people with cancer, but early diagnosis is vital.”

Kate Collins, chief executive of the Teenage Cancer Trust, said: “Too often, young people with cancer are forgotten or overlooked, especially in data collection, making them invisible in the system.”

“The fact that the pandemic has delayed diagnosis is an enormous concern.”

“It is essential to understand not only the reasons why the pandemic affected diagnosis but the impact this is having on children and young people with cancer, and what they need now from the healthcare services who care for them.”

 

The study was funded by the University of Oxford.

No relevant financial relationships declared.

NCRI Festival: Abstract 3439. Presented November 12.

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