Impact of COVID-19 pandemic on diagnostic pathology in the Netherlands

Abstract

Background The COVID-19 pandemic has a huge impact on healthcare provided. The nationwide pathology registry of the Netherlands, PALGA, offers an outstanding opportunity to measure this impact for diseases in which pathology examinations are involved. Methods Pathology specimen numbers in 2020 were compared with specimen numbers in 2019 for 5 periods of 4 weeks, representing two lockdowns and the periods in between, taking into account localization, procedure and benign versus malignant diagnosis. Results The largest decrease was seen during the first lockdown (spring 2020), when numbers of pathology reports declined up to 88% and almost all specimen types were affected. Afterwards each specimen type showed its own dynamics with a decrease during the second lockdown for some, while for others numbers remained relatively low during the whole year. Generally, for most tissue types resections, cytology and malignant diagnoses showed less decrease than biopsies and benign diagnoses. A significant but small catch-up (up to 17%) was seen for benign cervical cytology, benign resections of the lower gastro-intestinal tract, malignant skin resections and gallbladder resections. Conclusion The COVID-19 pandemic has had a significant effect on pathology diagnostics in 2020. This effect was most pronounced during the first lockdown, diverse for different anatomical sites and for cytology compared with histology. The data presented here can help to assess the consequences on (public) health and provide a starting point in the discussion on how to make the best choices in times of scarce healthcare resources, considering the impact of both benign and malignant disease on quality of life.

The impact of the COVID-19 pandemic on diagnosis and treatment of patients with soft tissue and bone sarcomas or aggressive benign musculoskeletal diseases: A single-center retrospective study (SarCorD study)

“…As also observed in other studies investigating the number of new diagnoses of solid tumors, in our study, we observed a decrease in new diagnoses during the first trimester of the pandemic, with a recovery in the following months ( 12 , 14 – 21 ). We also analyzed the type of the first visit made and we noticed a reduction in the number of all types of accesses.…”

“…In a study conducted by Ferrara and colleagues in Central and Northern Italy, a 44.9% reduction in new cancer diagnoses in 2020 was registered, with skin melanoma being the most affected tumor with a 56.7% reduction, followed by colorectal cancer (46.6%), prostate cancer (45%), and bladder cancer (43.6%) ( 13 ). Several studies have shown similar data, with a reduction in new cancer diagnoses in spring 2020 and a recovery to 2019 numbers in the second half of the year ( 14 – 21 ). In literature, different studies analyzed whether there was a diagnostic delay due to the COVID-19 pandemic in different cancer types, showing in most cases that a high standard of care had been maintained during the COVID-19 peak of the pandemic, with for example no delay between diagnosis and treatment in head and neck cancers and no diagnostic or treatment onset delay in lung cancers ( 12 , 22 ).…”

Whole-population trends in pathology-confirmed cancer incidence in Northern Ireland, Scotland and Wales during the SARS-CoV-2 pandemic: A retrospective observational study

“…These factors resulted in reductions in cancer presentation via all avenues, especially in primary care and outpatient departments [2] , [3] . These processes were affected by decisions made early in the pandemic to prioritise essential health services in primary and secondary care to manage COVID -19 patients and impose strict infection control measures in the UK and across Europe [4] , [5] , [6] , [7] , [8] .…”

Changes in the quality of cancer care as assessed through performance indicators during the first wave of the COVID-19 pandemic in 2020: a scoping review

“…The COVID-19 pandemic has widely affected cancer care delivery in these countries. Substantial declines in the number of cancer diagnoses have been reported in the Netherlands [4][5][6], Spain [7], Belgium [8], and Denmark [9]. While trying to minimize the risk of COVID-19 disease in cancer patients, changes in practice were pursued by oncologists, according to each setting's capacity and recommendations released by oncology societies [10][11][12].…”