Fewer cancer diagnoses during the COVID-19 epidemic in the Netherlands

The chaos caused by COVID-19 has brought about substantial changes in cancer diagnosis in the Netherlands. Data from the Netherlands National Cancer Registry for the period from February 24, 2020 to April 12, 2020, which are based on the initial determination of cases through pathological cancer notifications from the National Network Histopathology and Cytopathology show that there is a notable decrease in cancer diagnoses compared to the period prior to the COVID-19 outbreak. This effect was most pronounced for skin cancers (figure) and was observed in all age groups and geographic regions, and in almost all cancer sites (appendix). Several arguments could explain this decrease. First, people with potential nonspecific cancer symptoms may have barriers to consulting a general practitioner, including moral concerns about wasting general practitioner time for non-COVID-19-related symptoms, assumptions about insufficient capacity for non-essential COVID-19 related health care services and anxiety about acquiring COVID-19 in a health care setting. Secondly, most general practice consultations for non-acute problems are transferred to telehealth. A general practitioner could therefore postpone initial investigations to detect symptoms that do not immediately point to a possible cancer diagnosis, resulting in delayed or postponed hospital referrals. Third, hospitals may have postponed the diagnostic evaluation or have longer response times for the diagnostic evaluation because many hospital resources are being allocated to address COVID-19. Lastly, national breast, colorectal, and cervical cancer screening programs are temporarily suspended beginning March 16, 2020, to alleviate demand from the healthcare system due to COVID-19. The effect of this pause on cancer diagnosis may be more pronounced after long follow-up periods. However, this effect may be less noticeable for cervical cancer because screening is intended to identify precancerous lesions. Collectively, fewer cancer diagnostic factors in the COVID-19 era will result from patient, physician, and system factors.