Number of cancer diagnoses decreased sharply during corona peak. How can this be prevented?
What impact does the COVID-19 epidemic have on cancer care? It already became clear two months ago that the number of cancer diagnoses decreased sharply during the peak of the corona outbreak. Together with the Integraal Kankercentrum Nederland (IKNL), hospitals, GPs and patient organizations, UMC Utrecht is researching how care can be improved during a second wave. 

This spring, hospitals had to quickly pull out all the stops in the care for corona patients in response to the sharp increase in the number of patients. This inevitably impacted the care they normally provide. Cancer diagnosis tests, for instance, were on average longer in coming. And population screenings for colon, breast and cervical cancer were halted for over two months. Some people may have been afraid to go to their GP with complaints, for fear of infection or because they thought the doctor was too busy with corona patients. The result: the number of cancer diagnoses decreased by 27%. For skin cancer, the decrease was as much as 61%. And that is a lot, says Carla van Gils, Professor of Clinical Epidemiology of Cancer and coordinator of the research program Cancer.

Together with hospitals and patients
This prompted Carla to initiate a two-year study of the factors that have played a role in the delayed diagnoses and treatments. In this project, she works together with IKNL (the Netherlands comprehensive cancer center) and NFK (Dutch federation of cancer patients) and other organizations, such as DHD (Dutch Hospital Data), PALGA (the nationwide network and registry of histo- and cytopathology in the Netherlands) and SONCOS (the platform for cooperation in oncology care). "We'll be looking at the entire healthcare chain, from initial complaint to treatment, in order to identify the extent of the negative and positive effects of the COVID-19 outbreak. We want to know exactly which factors delayed or changed care and for whom," Carla explains. In their study, the researchers use healthcare data collected from databases of GPs, hospitals and NKR, the Netherlands Cancer Registry. They combine this with experiences of patients and healthcare professionals.
Researchers from UMC Utrecht focus mainly on cancer diagnostics in GP practices in the Netherlands. They will analyze the diagnostic intervals in GP practices during corona. They are able to compare this perfectly with the situation before the corona period, because they have just completed a study in which it was found that the interval from the first symptom to the visit to the GP ranged from about 5 to 31 days for different cancer types. The general practitioner then took 1 to 14 days for a referral. After that, it took another 6 to 49 days before the diagnosis in the hospital was made. This is usually acceptable to patients. GP researcher Nicole van Erp hopes to obtain her PhD for this study on 29 October. In the new project, researchers will determine the extent to which these intervals have changed during corona.  

Strategy for second wave
Ultimately, the researchers will try to determine which favorable adjustments in cancer care should be maintained and what lessons can be learned for the future. This is important when making up for missed care and also in the event of a second wave. “If the pressure on care becomes severe again, it is not unlikely that certain other care will also have to be postponed again. Our study will enable us to identify where the greatest effects occurred during the first wave and how healthcare professionals and patients experienced this. If there is a second wave, we will know more about who specifically the care avoiders are and also whether we should encourage groups with certain symptoms to request care, for example.”
“We expect that the impact of the COVID-19 outbreak on cancer care will differ for each type of tumor," Carla adds. “So we will also need different strategies to reduce the negative effects for patients. But we really have to prevent care avoidance and health loss. At the same time, such strategies can further encourage the positive effects, such as reduced travel time due to video consultations and eHealth." The initial results of the project will be available to GPs, hospitals and other stakeholders within four to six months. "We don't know whether this will be before any second wave, but we are doing our best to translate the results into recommendations and distribute these as quickly as possible."