Cancer care has dramatically changed as a result of the measures taken during the COVID-19 pandemic: many patients have not been going to their GPs, or putting it off, and have been referred to the hospital later. Consequently, a quarter fewer cases of cancer have been diagnosed for several weeks, as found by the Netherlands Cancer Registry based on initial diagnoses in the PALGA pathology database.
Dr. Avinash Dinmohamed of the Netherlands Comprehensive Cancer Organisation (IKNL in Dutch) and Prof. Sabine Siesling of IKNL and the University of Twente and colleagues report this decline in diagnoses in the highly regarded scientific journal Lancet Oncology. Prof. Siesling explains: 'This data on cancer diagnoses in the Netherlands is one of the most unique in the world because of the nationwide coverage and the promptness with which it is made available. Based on it, we can respond rapidly to the decline in diagnoses. Other countries may be able to confirm their suspect feelings on effects of the crisis based on the Dutch trends and to take measures to ensure that regular care is resumed covering all parts of the care pathway.'
Sharing the Dutch data with care professionals and researchers throughout the world enables other countries that do not have up-to-date (national) records to respond to the decline in diagnoses. Thanks to the long-standing and close collaboration between IKNL and the national pathological archive PALGA, we gain a comprehension of the number of cancer diagnoses in the Netherlands only two weeks after samples of tumor material (e.g. biopsies) are taken. This system is one of the most unique in the world. The data shows that diagnoses have declined, and the government has, therefore, called upon people to go to their GP if they have complaints. It has also prompted hospitals and GPs to make strenuous efforts to resume non-COVID-related care and, more specifically, cancer care. Most recent data show an increase in cancer diagnosis for skin and breast cancer, but for most other cancer types no increase can be seen.
Decline in diagnoses
At the low point of the corona crisis, cancer diagnoses excluding skin cancer were approximately a quarter fewer than the usual number per week. The decline was probably due to deferred GP visits and referrals and the postponement of hospital diagnosis.
In the case of skin cancer, the number of diagnoses was even more than halved for several weeks. The most common types of skin cancers, such as squamous cell carcinomas, are found particularly in the elderly, who may be avoiding visiting their GP for fear of COVID-19. The potential harm caused by late diagnosis of these most common types of skin cancer would seem to be limited as these are seldom life-threatening. Nevertheless, there is a backlog of care to be provided. For many other types of cancer there continue to be fewer diagnoses and the backlog will need to be dealt with to avoid adverse effects of late diagnosis and treatment.
Internationally unique data
Thanks to expedited review and publication process by Lancet Oncology, the results have been published up to the end of Week 15. These results have drawn the attention of researchers and care professionals across the globe, who can take action based on the information to meet the challenge of maintaining cancer care during the pandemic in their respective countries. The Netherlands Cancer Registry and PALGA are unique internationally because of the nationwide coverage and the promptness with which the data are made available. From the data, we are learning how to improve health care progressively. Also, it enables us to have rapid information on the numbers of diagnoses during the corona crisis. Based on the trends we observed in the Netherlands, other countries can gauge what effect the crisis is having on cancer care there.
In addition to numbers of diagnoses, IKNL monitors the effects of the COVID-19 crisis on treatment patterns and, ultimately, treatment outcomes.
Dinmohamed, A.G., et al. (2020) Fewer cancer diagnoses during the COVID-19 epidemic in the Netherlands. Lancet Oncology. doi.org/10.1016/s1470-2045(20)30265-5.