CG REPORT 1: The Impact of COVID-19 First Wave Restrictions on Cancer Care
The COVID-19 pandemic created widespread global disruption to health, education, and economies. However, various restrictions that aimed to contain the effects of the virus, may have adversely affected non-COVID care such as cancer.
Cancer is a leading cause of death worldwide, accounting for nearly ten million deaths in 2020. Up to half of the cancers could be prevented by effective prevention strategies, particularly through avoiding risk factors, better early detection and the use of appropriate evidence-based treatments. We, therefore, sought to synthesise the evidence assessing the effects of restrictions on cancer care that were applied in 2020 compared to pre-pandemic levels.
We found 69 published studies that compared changes in the patterns of screenings, diagnoses, waiting lists and treatments for cancer during the pandemic period in 2020 with pre-pandemic levels. We found analyses for the following types of cancer: eye, gynaecological, liver, lung, maxillofacial, cervical, urology, head & neck, lung, skin, oral, breast, colorectal; as well as studies covering radiotherapy, screening programmes, and surgical cancer delay.
Pandemic-related restrictions appear to have had a large impact on cancer diagnostics and access to care. Reductions were reported in screening attendance, diagnostics, treatments, and deaths across various cancers during the pandemic’s first wave in 2020 and in some cases after the lifting of restrictions.
All Cancers – Significant reductions in cancer reporting were noted in the US, Brazil, the Netherlands, Denmark, India, and Portugal. In the US, large reductions in cancer registrations were observed for breast (-48%); prostate (-49%); melanoma (-48%); lung (-39%); colorectal (-40%), and hematologic cancers (-39%) across twenty health care institutions covering more than 28 million patients.
Cancer Diagnosis – Rates of cancer diagnoses fell significantly in Italy, Germany, the Netherlands, the UK, and the US.
Breast Cancer – Significantly fewer suspected breast cancer referrals were reported during the pandemic in the UK, the US, Italy, Taiwan, and China. In the US, mammography rates declined by approximately 95% in April 2020 and took till July to rebound to normal levels.
Cervical Cancer – In the US, screening rates for cervical cancer were significantly lower both during the pandemic and after stay-at-home orders were lifted.
Colorectal Cancer – New diagnoses of colorectal cancer decreased in Spain, the UK, Japan, Taiwan, and Italy.
Head & Neck Cancer – A three-fold increase in advanced cancer stages diagnoses were reported in Italy, and the rate of advanced tumours increased for patients in Turkey.
Lung Cancer – Hospitalisations for lung cancer-related operations decreased significantly in China, and the US reported reduced lung cancer screen rates.
Oral Cancer – Identified cases and/or hospitalisations decreased in Brazil and Italy.
Paediatric Cancer – A major Paediatric Oncology Department in Turkey reported reduced outpatient visits and a drop in the average number of patients undergoing daily chemotherapy, radiotherapy, surgery, and imaging during the ‘COVID-19 period’ (10 Mar to 31 Oct 2020).
COVID-19 Fear and Anxiety – “Pandemic fear” and other COVID-19 related concerns were found to have influenced individuals’ decisions to seek cancer-related medical care in Taiwan, Turkey, and Italy.
Restrictive measures in the first wave of the COVID19 pandemic in 2019-20 led to wide-scale, global disruption of cancer care. Some of these issues may be rectified by policy measures such as teleconsulting, better transport, and increasing intensive care capacity to prevent cancellations of life-saving surgery. Future restrictions should consider disruptions to the cancer care pathways and plan to prevent unnecessary harm.
Quality of Evidence
The majority of the evidence was from high-income countries; however, those in low and middle-income countries are likely to be equally affected. Updates to this review will seek to refine the search and ensure as the evidence evolves relevant studies that may have been missed are retrieved. We did not assess the quality of individuals’ studies. Clinical audit studies, however, remain a valuable tool for improving care as they require data analysis and changes, or as in the case of restrictive measures, restoring care to normal levels efficiently. We aerated the quality of the evidence as low to moderate as further high-quality evidence (particularly with longer-term follow-up) is likely to change these estimates.