Impact of the COVID-19 epidemic on cancer burden and cancer care in Slovenia: a follow-up study

Abstract

Background In Slovenia, cancer care services were exempt from government decrees for COVID-19 containment. Nevertheless, cancer control can be impacted also by access to other health services and changes in health-seeking behaviour. In this follow up study, we explored changes in cancer burden and cancer care beyond the first months after the onset of the COVID-19 epidemic. Materials and methods We analysed routinely collected data for the period January 2019 through July 2022 from three sources: (1) pathohistological and clinical practice cancer notifications from two major cancer centres in Ljubljana and Maribor (source: Slovenian Cancer Registry); (2) referrals issued for oncological services (source: e-referral system); and (3) outpatient appointments and diagnostic imaging performed (source: administrative data of the Institute of Oncology Ljubljana – IOL). Additionally, changes in certain clinical and demographic characteristics in patients diagnosed and treated during the epidemic were analysed using the Hospital-Based Cancer Registry of the IOL (period 2015–2021). Results After a drop in referrals to follow-up cancer appointments in April 2020, in June-August 2020, there was an increase in referrals, but it did not make-up for the drop in the first wave; the numbers in 2021 and 2022 were even lower than 2020. Referrals to first cancer care appointments and genetic testing and counselling increased in 2021 compared to 2019 and in 2022 increased further by more than a quarter. First and follow-up outpatient appointments and cancer diagnostic imaging at the IOL dropped after the onset of the epidemic in March 2020 but were as high as expected according to 2019 baseline already in 2021. Some deficits remain for follow-up outpatients’ appointments in surgical and radiotherapy departments. There were more CT, MRI and PET scans performed during the COVID-19 period than before. New cancer diagnoses dropped in all observed years 2020, 2021 and until July 2022 by 6%, 3% and 8%, respectively, varying substantially by cancer type. The largest drop was seen in the 50−64 age group (almost 14% in 2020 and 16% in 2021), while for patients older than 80 years, the numbers were above expected according to the 2015–2019 average (4% in 2020, 8% in 2021). Conclusions Our results show a varying effect of COVID-19 epidemic in Slovenia for different types of cancers and at different stages on the patient care pathway – it is probably a mixture of changes in health-seeking behaviour and systemic changes due to modifications in healthcare organisation on account of COVID-19. A general drop in new cancer cases reflects disruptions in the pre-diagnostic phase and could have profound long-term consequences on cancer burden indicators.

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

“…Breast. In Greater Poland, in 2020, the number of new female breast cancer cases was 12% lower than expected, which is consistent with observations from other former Eastern Bloc countries, including Hungary (-16%) ( 35 ) and Slovenia (-17%) ( 5 ). A smaller incidence gap was observed in Western Europe, namely Belgium (6%) ( 24 ) and Denmark (8%) ( 3 ).…”

“…According to literature, cancer morbidity in Europe was reduced in 2020, especially between March and May, from 22% in Sweden to 66% in Spain ( 1 ). Reports encompassing the entire 2020 period presented a lower and somewhat similar decrease in incident cancer cases compared to 2019 – 6% in Denmark ( 3 ), 6% in Sweden ( 4 ), 4% in Finland ( 4 ), and 6% in Slovenia ( 5 ). Although extensive research has been carried out on the influence of the pandemic on observed cancer incidence, no single study has compared the observed number of cases to the expected one in the Polish population, meaning that existing studies may have underestimated the influence of the pandemic by not considering the predicted year-to-year increase in cancer incidence.…”

The impact of the COVID-19 pandemic on incidence gap in screen-detectable cancers: a cohort study in Greater Poland, Poland

“…In Greater Poland, the number of new female breast cancer cases in 2020 was 12% lower than expected. Similar observations were made in other former Eastern Bloc countries, including Hungary (-16%) [28] and Slovenia (-17%) [9]. Western European countries, such as Belgium (6%) [23] and Denmark (8%) [7], had smaller incidence gaps.…”

“…Western European countries, such as Belgium (6%) [23] and Denmark (8%) [7], had smaller incidence gaps. Notably, in Slovenia, the number of newly diagnosed breast cancer cases in the screening group was only 4% lower in 2020 [9]. Although stage at diagnosis did not show differences in patients diagnosed in 2020 [32], delays in breast cancer diagnosis are expected to impact staging in the years following the pandemic.…”

“…Reported cancer morbidity in Europe was reduced in 2020 compared to 2019: 6% in Denmark [7], 6% in Sweden [8], 4% in Finland [8], and 6% in Slovenia [9]. Other studies under review report that in the Greater Poland region of Poland, the reduction was more pronounced, with a 20% decrease in the registered number of cancer cases in males and 17% in females.…”