Delays in Cancer Diagnostic Testing at a Quick Referral Unit in Spain during COVID-19

Abstract

Although COVID-19 has had dire consequences on diagnosis of cancer, little data assessing its impact on the whole range of diagnostic activity relevant to cancer are available. We examined trends in the provision of full diagnostic tests for consecutive patients with suspected cancer referred to an academic hospital-based Quick Diagnosis Unit from January 2019 to December 2020. As weekly volumes declined, waiting times for endoscopic, imaging and biopsy/cytology procedures increased steeply during the COVID-impacted period (26 February–28 April 2020). The average weekly increase compared with the same period in 2019 was substantial for invasive procedures requiring admission (200.70%), CT scans (171.20%), GI endoscopy (161.50%), PET/CT scans (152.50%), ultrasonography (148.40%), and ambulatory biopsy/cytology procedures (111.20%). Volumes and waiting times to other procedures showed similar trends. There was a remarkable downward trend in cancer diagnosis during the COVID-impacted period, with a 54.07% reduction compared with the same weeks in 2019. Despite a modest recovery in the following months, the decline in weekly activity and cancer rates persisted until 30 December. Providing insight into how COVID-19 changed the full spectrum of diagnostic activity for suspected cancer informs resilience-building interventions to guarantee access to fast and efficient diagnostics ahead of new threats.

Time intervals in the care pathway to cancer diagnosis during the COVID‐19 pandemic: A large retrospective study from a high‐volume center

“…As reported by authors from different countries and by our group, declining trends have been attributed to a combination of patient and health system factors, most notably a decrease in the number of patients presenting in PC, a decrease in the number of early referrals from primary to secondary care, and major setbacks at secondary care with hospitals reassigning healthcare resources to pandemic preparedness. 17 , 18 , 29 , 30 , 31 , 32 , 33 , 34 Consistent with reported findings, the number of cancers in our study decreased from an average of 70 per month in the pre‐COVID period to 51 per month in the early period, or a relative reduction of 27.1%. An upward trend was observed afterwards into the mid‐period, in which the monthly average was 59, representing a 15.7% reduction compared to the nonpandemic average.…”

“…Primary care constitutes the referral source for 40% to 45% of patients and 20% to 25% of them are diagnosed with cancer. 17 Further, up to 30% of patients referred from the ED, the main source for referral, have a diagnosis of cancer. 18 The operating procedures, staffing and referral criteria have been described elsewhere.…”

“…As a result, both for cancer and noncancer patients, diagnosis was markedly delayed. 17 Although changes in referral patterns and cancer detection rates following the pandemic declaration are well documented, evidence on its impact on Aarhus statement‐defined time intervals from symptom onset to diagnosis is lacking. We therefore set out to examine differences in the length of intervals in the diagnostic pathway for a range of common cancers in patients presenting with suspected symptoms before and during the course of the pandemic.…”

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

“…In the first pandemic wave, health systems were subjected to sudden and overwhelming pressure. 2 , 3 In cancer, this meant delaying diagnoses 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 and altering treatment regimens. 30 , 31 , 42 , 43 , 44 , 45 , 46 , 47 Subsequent pandemic waves, including the one linked to the omicron variant, have triggered new health crises.…”

The Impact of SARS-CoV-2 Pandemic on Patients with Malignant Melanoma at a Romanian Academic Center: A Four-Year Retrospective Analysis

“…Consequently, early diagnosis and surgical treatment of initial melanomas are crucial since timely diagnosis is critical for the survival of the patients [ 24 ]. Due to a probable decline in diagnoses of early-stage melanomas and delays in the presentation of patients with thicker tumors, the lower degree of access to medical treatment during COVID-19 poses a medical issue [ 25 ].…”