COVID Has Delayed Diagnoses and Decreased Survival in Cancer

Frédéric Soumois

June 01, 2022

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BRUSSELS — Karol Sikora, PhD, a world-renowned British oncologist known in particular as former chief of the World Health Organization's cancer program, recently published an alarming article. In summary, it reported the following: "Estimates vary, but we know that tens and tens of thousands of people [in the United Kingdom] are unknowingly developing cancer and, in previous years, would have received a much earlier diagnosis. This is in addition to those diagnosed with significant delays and the thousands of people whose treatment was significantly interrupted or even completely stopped. This [has had] catastrophic effects on overall survival."

How does the situation in Belgium compare? MediQuality spoke with Jean-Pascal Machiels, MD, PhD, head of the department of medical oncology of Saint-Luc University Clinics (Louvain Catholic University) and head of the department of adult and pediatric oncology and hematology (King Albert II Institute), also at Louvain Catholic University, Brussels, Belgium.

MediQuality: Is our situation as dire as that in the UK?

Machiels: The Belgian Cancer Registry closely monitored the number of cancer diagnoses during the first 2 years of the COVID-19 pandemic in Belgium. During the first wave of the pandemic in April 2020, invasive cancer diagnoses decreased by 43%. After this first wave, cancer diagnoses almost returned to normal for the remainder of 2020. In 2021, the number of diagnoses is starting to return to prepandemic levels. It's worth bearing in mind, however, that diagnoses made during these two pandemic years are still 2% lower compared to 2019, or in other words, there have been 2700 fewer cancer diagnoses. While diagnosis levels seem to have recovered for younger groups and certain types of cancer, the decrease in diagnoses remains for most types of cancer and in the elderly (older than age 80). Since early cancer diagnosis is key to a favorable prognosis, it is still important to continue recommending a doctor's appointment in the event of (persistent) symptoms.

For me, one group continues to be underdiagnosed. The numbers also change depending on the disease, on the social setting, and whether there is routine screening for that particular type of cancer. An increase in the number of cancers was expected overall. As the population ages, diagnoses should increase by 1% or 2% per year. Yet, the number remains low. This indicates underdiagnosis and continued underdiagnosis.

MediQuality: Sikora has suggested multiple causes: During the pandemic, hospitals became dangerous places instead of the solution. This was coupled with fear of leaving home, even to see a general practitioner (GP). What are your thoughts on this?

Machiels: Actually, screening stopped for several months. But some patients were also afraid to go to hospital, others were afraid to see their GP for fear of catching COVID. People were afraid to bother doctors who had "other things to do." All these factors have contributed to delayed diagnoses. Today, these concerns might still exist, but it's hard to tell. Are people delaying their consultations? Are they still afraid of the hospital? I would say yes to some degree because the hospital is the only place where masks and all precautions are still required. GPs are still overworked, there aren't enough care staff, and caregivers are tired. All of this can play a role.

MediQuality: We know that one day, another pandemic will come knocking. We can only speculate when it will happen and how contagious it will be. What should we put in place today to better resist this pandemic's effects on other critical illnesses?

Machiels: We have to analyze what happened this time around very closely. In terms of cancer, it's still a bit early to tell what the consequences on survival will be. Within the next 3 or 4 years, the survival of cancer patients from 2019 to 2022, with a slightly delayed diagnosis, should be analyzed. This analysis should investigate which types of cancer saw a decrease in survival. I worry when I see the numbers published by the national cancer registry, because there are 900 cases of undiagnosed colon cancer. Yet we know that an early cancer diagnosis increases the likelihood of recovery. What's more, the screening process is extremely effective. In theory, having every 50-year-old undergo a colonoscopy or validated screening (blood-in-stool test) would significantly decrease the occurrence of this cancer. A thorough analysis in the coming years of the impact on survival is essential. This also stands for other cancers (such as breast cancer).

Then, if a new pandemic occurs, there are two things to consider. The first is to use the analysis of the impact on survival to never stop screening for breast or colon cancer. A "fast track" system should also be created for people with cancer symptoms. The analysis will tell us to what extent and how to focus on this.

The second point is to simplify ongoing care for diagnosed patients. Continued access to care is needed. We were successful at Saint-Luc University Clinics. For all patients undergoing chemotherapy or other treatments, we received tremendous support from the hospital to continue these treatments almost as we had been prepandemic. We created [tracks] for these patients, even those who had COVID. Even for surgical procedures, and operating rooms were reserved for them. I think we did well, but this wasn't the case everywhere. If you have cancer that you think can be cured by surgery, you can't risk delaying it several weeks.

MediQuality: We know that fake news heavily impacted the public perspective of COVID-19. The causes and solutions continue to attract controversy, believers, and nonbelievers to this day. What is needed for accurate and verified information, even when changed or criticized, to reach patients more than tweets and rumors?

Machiels: I think the media has a very important role to play. Naturally, we can't silence certain voices, but experts should have the mic. This did happen; we saw lots of interviews with experts during the pandemic. Through the media, I would tell patients to see a doctor, that if they had a significant cancer symptom, that type of care was a priority at the hospital. It's of the utmost importance. Just because something is attracting all the attention doesn't mean nothing else matters. We have to look at what else is happening. The College of Oncology very quickly sent out [a statement] recommending a consultation if cancer symptoms appear. Survival improves with early diagnosis. Even a delay of only a few weeks has a considerable impact on survival rates. With this in mind, people need to be encouraged to resume screening and to come for a consultation if symptoms appear.

This article was translated from MediQuality.

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