Childhood, teenage and young adult cancer diagnosis during the first wave of the COVID-19 pandemic: a population-based observational cohort study in England

Abstract

ObjectiveTo investigate childhood, teenage and young adult cancer diagnostic pathways during the first wave of the COVID-19 pandemic in England.DesignPopulation-based cohort study.Setting and participantsQResearch, a nationally representative primary care database, linked to hospital admission, mortality and cancer registry data, was used to identify childhood, teenage and young adult cancers (0–24 years) diagnosed between 1 January 2017 and 15 August 2020.Main outcomesMain outcomes of interest were: (1) number of incident cancer diagnoses per month, (2) diagnostic, treatment time intervals and (3) cancer-related intensive care admissions.Results2607 childhood, teenage and young adult cancers were diagnosed from 1 January 2017 to 15 August 2020; 380 were diagnosed during the pandemic period. Overall, 17% (95% CI −28.0% to −4.0%) reduction in the incidence rate ratio of cancers was observed during the pandemic. Specific decreases were seen for central nervous system tumour (−38% (95% CI −52% to −21%)) and lymphoma (−28% (95% CI −45% to −5%)) diagnoses. Additionally, childhood cancers diagnosed during the pandemic were significantly more likely to have intensive care admissions (adjusted OR 2.2 (95% CI 1.33 to 3.47)). Median time-to-diagnosis did not significantly differ across periods (+4.5 days (95% CI −20.5 to +29.5)), while median time-to-treatment was shorter during the pandemic (−0.7 days (95% CI −1.1 to −0.3)).ConclusionsCollectively, our findings of a significant reduction in cancer diagnoses and increase in intensive care admissions provide initial insight into the changes that occurred to childhood, teenage and young adult cancer diagnostic pathways during the first wave of the pandemic.

Decrease in the number of new cancer diagnoses during the first year of the COVID-19 pandemic – cohort study of 3.5 million individuals in western Poland

“…They might relate to the fact that stay-at-home advice was addressed mainly to seniors. Contrary to an English study, which reported a decrease in new childhood cancer diagnoses ( 29 ), neither our analysis nor Canadian ( 30 ) or German ( 31 ) reports confirmed such a trend.…”

Cancer diagnosis in Catalonia (Spain) after two years of COVID-19 pandemic: an incomplete recovery

“…Worldwide, substantial disruptions in pediatric cancer diagnosis and management were described in the first pandemic wave, particularly in low- and middle-income countries. 74 Whereas a study conducted in the UK reported a significant reduction in cancer diagnoses during the first wave, 75 however, two studies from Canada and Germany 76 , 77 did not find a decrease in the first pandemic year. These heterogeneous published data, combined with the insufficient statistical power of our pediatric series which did not allow us to analyze incident cases according to pandemic waves for all tumor types, mean that our estimates must be interpreted with great caution.…”

Impact of the COVID‐19 pandemic on paediatric renal tumour presentation and management, a SIOP renal tumour study group study

“…We are confident that tumour volume has been accurately measured and registered, since the evaluation of volume reduction after pre‐operative chemotherapy are among the endpoints of the ongoing UMBRELLA study. Previously pursued, similar studies had been conducted by paediatric cancer registries with various cancers, or single‐centred experience from a regional institute 9,20,32,45,46 . In the latter studies, influence of the pandemic on tumour characteristics, delay of diagnosis and starting treatment of the paediatric cancers could not be taken into account as specifically.…”

“…The aforementioned reports reflect mostly either adult cancer and/or national cancer registry perspectives. Therefore, the possibility to ascertain the impact on individual cancer types and organisation of care for subsets of patients on a global scale is still limited 23,29–32 . The paediatric oncology setting in general is different with respect to referral speed, based on the need for rapid management of the most highly proliferating cancer types in childhood.…”

“…Therefore, the possibility to ascertain the impact on individual cancer types and organisation of care for subsets of patients on a global scale is still limited. 23 , 29 , 30 , 31 , 32 The paediatric oncology setting in general is different with respect to referral speed, based on the need for rapid management of the most highly proliferating cancer types in childhood. Therefore, our aim is to report on the impact of the first phase of the pandemic on time to diagnosis, presenting symptoms, tumour characteristics (volume and stage), and potential delay in management of paediatric renal tumour patients registered in the International Society of Paediatric Oncology Renal Tumour Study Group (SIOP‐RTSG) UMBRELLA prospective clinical study.…”