Fewer head and neck cancer diagnoses and faster treatment initiation during COVID-19 in 2020: A nationwide population-based analysis

Abstract

Background Inevitably, the emergence of COVID-19 has impacted non-COVID care. Because timely diagnosis and treatment are essential, especially for patients with head and neck cancer (HNC) with fast-growing tumours in a functionally and aesthetically important area, we wished to quantify the impact of the COVID-19 pandemic on HNC care in the Netherlands. Material and Methods This population-based study covered all, in total 8468, newly diagnosed primary HNC cases in the Netherlands in 2018, 2019 and 2020. We compared incidence, patient and tumour characteristics, primary treatment characteristics, and time-to-treatment in the first COVID-19 year 2020 with corresponding periods in 2018 and 2019 (i.e. pre-COVID). Results The incidence of HNC was nearly 25% less during the first wave (n=433) than in 2019 (n=595) and 2018 (n=598). In April and May 2020, the incidence of oral cavity and laryngeal carcinomas was significantly lower than in pre-COVID years. There were no shifts in tumour stage or alterations in initial treatment modalities. Regardless of the first treatment modality and specific period, the median number of days between first visit to a HNC centre and start of treatment was significantly shorter during the COVID-19 year (26 – 28 days) than pre-COVID (31 – 32 days, p<0.001). Conclusion The incidence of HNC during the Netherlands’ first COVID-19 wave was significantly lower than expected. The expected increase in incidence during the remainder of 2020 was not observed. Despite the overloaded healthcare system, the standard treatment for HNC patients could be delivered within a shorter time interval.

Response to “Head and neck cancer diagnoses and faster treatment initiation during COVID-19: Correspondence”

“…We agree that the decline in the number of diagnoses during the first wave is likely related to reluctance of patients to visit their general practitioner with tumour-related symptoms and the limited access of care. However, if this could solely be explained by reluctance and limited access, an increase in head and neck cancer diagnoses after the first wave would be expected, a phenomenon we did not observe during the subsequent second half of 2020 as can be observed in Figure 1A of our original article [2] . We think this might partly be explained by excess deaths due to other causes [2] .…”

“…However, if this could solely be explained by reluctance and limited access, an increase in head and neck cancer diagnoses after the first wave would be expected, a phenomenon we did not observe during the subsequent second half of 2020 as can be observed in Figure 1A of our original article [2] . We think this might partly be explained by excess deaths due to other causes [2] .…”

“…To support our finding that the number of diagnosed cases was significantly lower than expected, we compared the crude rate (number of cases per 1,000,000 population) in the year 2020 with the crude rates for 2018 and 2019 using the incidence rate ratio. The corresponding p-values can be found in the Supplementary Table 1 of our original article [2] . Part of this table is reproduced in Table 1 .…”

Impact of COVID-19 on head and neck mucosal squamous cell carcinoma: Correspondence

“…In contrast to another previous report from Europe, the current study's findings. There were fewer cancer diagnoses in that report [2] compared to the pre-COVID-19 period, which could be because malignant patients did not and could not get medical care during the COVID-19 outbreak period. Nonetheless, the rising number of cases of advanced cancer may be due to individuals' inability to obtain healthcare.…”

In reply to: Impact of COVID-19 on head and neck mucosal squamous cell carcinoma: Correspondence

“…The authors appreciate the opportunity to reply to the recent commentary [1] that notes that the increase in patients presenting with head and neck malignancy found in our study population [2] was not reflected in a similar European study [3] . Our key finding of mucosal squamous cell carcinoma patient's presenting with more advanced disease during the pandemic (specifically, more advanced N staging) has direct impact for treatment choice and long-term outcomes.…”