In a commentary published in The Lancet Oncology, Dinmohamed et al detailed a nationwide reduction in cancer diagnoses in the Netherlands in the several weeks following the first confirmed case of COVID-19 in the country compared with the several weeks preceding the first documented case. This reduction in diagnoses was particularly noted in skin cancer.
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As stated by the investigators, the Netherlands provides citizens with universal access to essential health-care services, with the general practitioner serving as the gatekeeper to secondary care.
Study Details
Data from the nationwide Netherlands Cancer Registry were used to compare numbers of cancer diagnoses per week during the period from February 24, 2020, through April 12, 2020, with diagnoses made between the week of January 6 and the week of February 17. The first confirmed case of COVID-19 infection in the Netherlands was diagnosed on February 27. During the period in the analysis, strict social distancing policies were implemented by the government as of March 15, and national screening programs for breast, colorectal, and cervical cancer were temporarily halted as of March 16 to ease demand on the health-care system.
Key Points
The investigators identified the following trends in numbers of diagnoses:
- Compared with the mean number of cancer diagnoses per week in the pre–COVID-19 period, the relative proportion of diagnoses per week ranged from 73% to 91% for all cancers except skin cancers, and from 39% to 75% for skin cancers (excluding basal cell carcinoma) during the COVID-19 period.
- For cancers other than skin cancers, reductions in diagnoses were observed in essentially all weeks in the COVID-19 period compared with all weeks in the pre–COVID-19 period for gastrointestinal cancers, lung cancer, breast cancer, urologic cancers, and hematologic cancers, but not for head and neck cancers or gynecologic cancers.
Potential factors in the reduction in diagnoses cited by the investigators included:
- Reluctance on the part of individuals with potential, nonspecific symptoms of cancer to consult a general practitioner (including moral concerns about wasting the general practitioner’s time for non–COVID-19-related symptoms).
- Assumptions about insufficient capacity for essential non–COVID-19-related health-care services.
- Anxiety about acquiring COVID-19 in a health-care setting.
- Postponement by general practitioners of initial investigations for symptoms that do not immediately hint towards a potential cancer diagnosis, resulting in delayed or postponed hospital referrals.
- Postponement by hospitals of diagnostic evaluation or longer turnaround times for diagnostic evaluation due to allocation of hospital-based resources to COVID-19 care and management.
- The halting of the national screening programs for breast, colorectal, and cervical cancers.
As related by the investigators, in response to the reduction in diagnoses, the Netherlands Comprehensive Cancer Organisation disseminated knowledge of the reduction to the public along with the following messages:
- Individuals were encouraged to consult their general practitioner whenever symptoms continued to be troublesome.
- General practitioners were encouraged to refer patients with suspected cancer to oncology specialists.
- An appeal was made to restart national cancer screening programs.
- Misconceptions were addressed regarding heightened risk of contracting COVID-19 in health-care settings due to inadequate policies for infection control at the institutional level and resource constraints in the delivery of essential oncology care.
The authors concluded, “This information can also guide the public, policymakers, and physicians in the future whenever an outbreak of a similar magnitude occurs.”
Sabine Siesling, PhD, of the Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, is the corresponding author for The Lancet Oncology article.
Disclosure: For full disclosures of the study authors, visit thelancet.com.
