An umbrella review of systematic reviews on the impact of the COVID-19 pandemic on cancer prevention and management, and patient needs

Abstract

The COVID-19 pandemic led to relocation and reconstruction of health care resources and systems, and to a decrease in healthcare utilization, and this may have affected the treatment, diagnosis, prognosis, and psychosocial well-being of patients with cancer. We aimed to summarize and quantify the evidence on the impact of the COVID-19 pandemic on the full spectrum of cancer care. An umbrella review was undertaken to summarize and quantify the findings from systematic reviews on impact of the COVID-19 pandemic on cancer treatment modification, delays, and cancellations; delays or cancellations in screening and diagnosis; psychosocial well-being, financial distress, and use of telemedicine as well as on other aspects of cancer care. PubMed and WHO COVID-19 Database was searched for relevant systematic reviews with or without meta-analysis published before November 29th, 2022. Abstract, full text screening and data extraction were performed by two independent reviewers. AMSTAR-2 was used for critical appraisal of included systematic reviews. 51 systematic reviews evaluating different aspects of cancer care were included in our analysis. Most reviews were based on observational studies judged to be at medium and high risk of bias. Only 2 of the included reviews had high or moderate scores based on AMSTAR-2. Findings suggest treatment modifications in cancer care during the pandemic versus the pre-pandemic period were based on low level of evidence. Different degrees of delays and cancellations in cancer treatment, screening and diagnosis were observed, with low-and-middle income countries and countries that implemented lockdowns being disproportionally affected. A shift from in-person appointments to telemedicine use was observed, but utility of telemedicine, challenges in implementation and cost-effectiveness in different areas of cancer care were little explored. Evidence was consistent in suggesting psychosocial well-being (e.g., depression, anxiety, and social activities) of patients with cancer deteriorated, and cancer patients experienced financial distress, albeit results were in general not compared to pre-pandemic levels. Impact of cancer care disruption during the pandemic on cancer prognosis was little explored. In conclusion, Substantial but heterogenous impact of COVID-19 pandemic on cancer care has been observed. Evidence gaps exist on this topic, with mid- and long-term impact on cancer care being most uncertain.

The COVID-19 pandemic did not negatively impact frequency or continuity of outpatient care in Alberta, Canada

“…For example, a recent US study reported that the frequency with which six established primary care screening quality measures were done declined by 2/3 in the early months of the pandemic and was still 1/3 lower when COVID-19 cases had declined markedly between the first and second waves 16 . Unfortunately, there are also now multiple analyses demonstrating declines in new cancer diagnoses and worsening prognosis for those detected (presumably later in their disease course) [17][18][19][20] as well as poorer maternal and fetal outcomes 21 during the COVID pandemic.…”

Prevalence of and factors associated with a treatment delay due to the COVID-19 pandemic in patients with gastrointestinal cancer in Europe

“…Previous studies have revealed a substantial impact of the COVID-19 pandemic on cancer care (Linjawi et al 2023 ). Depending on the geography and study design, varying degrees of delays and cancellations of cancer treatment, screening and diagnosis have been observed, leaving the medium- and long-term impact on cancer care uncertain (Muka et al 2023 ). By analyzing a total of 30,171 patients with gastrointestinal malignancies from five different European countries from IQVIA’s Oncology Dynamics (OD) database (Alymova et al 2022 ), we show that for 1342 (4.5%) patients, a treatment delay occurred.…”

“…The pandemic has also led to delays in diagnostic tests, imaging studies, and surgeries, resulting in longer wait times for the patients (Teglia et al 2022 ; Mazidimoradi et al 2021 ; Teng et al 2022 ; Dorri et al 2021 ). Moreover, the pandemic has discouraged many people from visiting cancer treatment facilities for fear of contracting the virus (Muka et al 2023 ). A recent umbrella review summarized and quantified the results of available systematic reviews on the impact of the COVID-19 pandemic on cancer treatment modification, delays, and cancellations (Muka et al 2023 ), showing a decrease in screening rates across all cancer types.…”

Flaws and uncertainties in pandemic global excess death calculations

“…Focused efforts should estimate excess deaths from various non‐COVID‐19 causes during 2020–2023 and beyond, for example, from disruption of healthcare services regarding acute cardiovascular disease, 52 chronic diseases such as cancer, 53 reversal in progress on infectious diseases such as malaria 54 or tuberculosis, 55 hunger/starvation, 56 mental health deterioration, 57 drug overdose epidemics 49 and diverse worsening circumstances 58 . The quality of relevant data varies across countries and extrapolations require great caution.…”