Impact of the COVID-19 pandemic on incidence, time of diagnosis and delivery of healthcare among paediatric oncology patients in Germany in 2020: Evidence from the German Childhood Cancer Registry and a qualitative survey

Abstract

Background The indirect impact of the COVID-19 pandemic on cancer care and timely diagnosis is of increasing concern. We investigated the impact of the COVID-19 pandemic on incidence, time of diagnosis and delivery of healthcare among paediatric oncology patients in Germany in 2020. Methods We analysed incident paediatric cancer cases diagnosed in 0- to 17-year olds in Germany in 2020 using data of the German Childhood Cancer Registry. Absolute numbers and age-standardised incidence rates (ASR) in 2020 were compared to the previous five years (2015–2019). Moreover, we conducted a survey with open-ended questions, gathering perceptions of the diagnostic process and healthcare delivery for paediatric oncology patients during the COVID-19 pandemic. Findings More or similar numbers of paediatric cancer patients were newly diagnosed each month throughout 2020 in comparison to the previous five years. The estimated ASRs showed markedly higher incidence rates, overall and across diagnostic groups, in 2020 compared to 2015-2019. Results from the qualitative survey indicated that diagnostic processes, timeliness of diagnosis, and delivery of treatment were hardly affected during the COVID-19 pandemic. However, psychosocial supportive care and non-urgent appointments were considerably reduced during the lockdown periods. Interpretation We found no indications of severe adverse effects of the COVID-19 pandemic on diagnosis and delivery of healthcare among children with cancer in Germany. The underlying reasons of the increase in incidence rates remain speculative. Continued close monitoring of incidence patterns may shed light on the underlying reasons of the present increase and contribute to understanding disease aetiology. Funding None

Decrease in the number of patients diagnosed with cancer during the COVID-19 pandemic in Germany

“…These findings were corroborated in a third study from Belgium, as there was a 44% reduction in the diagnoses of invasive cancers in this country in April 2020 compared with April 2019 (Peacock et al 2021 ). Similar results emerged from the majority of studies conducted in Germany at the early stage of the COVID-19 pandemic (Erdmann et al 2021 ; Piontek et al 2021 ; Reichardt et al 2021 ; Stang et al 2020 ; Voigtländer et al 2021 ). A study from Saxony revealed that the number of new cases of cancer decreased in this state between January and September 2020 compared with the same period in 2017–2019 (Piontek et al 2021 ), while another study, using data collected in North Rhine-Westphalia, reported a decrease in new cancer cases in January–September 2020 compared with 2019 (Stang et al 2020 ).…”

“…In the past months, a substantial body of literature has investigated the effects of the COVID-19 crisis on cancer diagnosis (Andrew et al 2021 ; De Luca et al 2021 ; Erdmann et al 2021 ; Gurney et al 2021 ; Jacob et al 2021 ; Kuzuu et al 2021 ; Patt et al 2020 ; Peacock et al 2021 ; Piontek et al 2021 ; Reichardt et al 2021 ; Ruiz-Medina et al 2021 ; Stang et al 2020 ; Tsibulak et al 2020 ; Vardhanabhuti and Ng 2021 ; Voigtländer et al 2021 ). For example, a study, using national data from New Zealand, showed that cancer registrations (new diagnoses of primary malignant cancers) declined by 40% in this country in March–April 2020 compared with 2018–2019, and that registrations increased in the subsequent months to reach pre-lockdown levels (Gurney et al 2021 ).…”

“…The deleterious effects of the COVID-19 pandemic on the care of acute and chronic disorders may be explained, at least partially, by overwhelmed healthcare systems (Tangcharoensathien et al 2021 ) and the fear of patients to consult primary care practices and emergency departments due to the potential risk of being infected by the SARS-CoV-2 (Czeisler et al 2020 ; Lazzerini et al 2020 ). Some literature also suggests that COVID-19 has been associated with a substantial decrease in cancer diagnosis (Andrew et al 2021 ; De Luca et al 2021 ; Erdmann et al 2021 ; Gurney et al 2021 ; Jacob et al 2021 ; Kuzuu et al 2021 ; Patt et al 2020 ; Peacock et al 2021 ; Piontek et al 2021 ; Reichardt et al 2021 ; Ruiz-Medina et al 2021 ; Stang et al 2020 ; Tsibulak et al 2020 ; Vardhanabhuti and Ng 2021 ; Voigtländer et al 2021 ). Interestingly, a study conducted in Germany found that cancer diagnoses decreased in March–May 2020 compared with March–May 2019, and this decrease was particularly strong for cancers of the skin and the respiratory and intrathoracic organs (Jacob et al 2021 ).…”

Natural Bioactive Molecules: An Alternative Approach to the Treatment and Control of COVID-19

“…Here, as consequence, the virus was dubbed a novel coronavirus in 2019. A coronavirus seems to be a single-stranded, encapsulated ribonucleic acid with surface spikes that are 9 to 12 nm long and mimics the solar corona [ 43 , 44 , 45 ]. The spike (S) protein interacts with the angiotensin-converting enzyme 2 (ACE2) receptor and facilitates viral entrance into the host cell by mediating fusion of the enveloped and host cell membranes, and the coronavirus genome encodes four key structural protein molecules on the surface [ 46 , 47 ].…”

Limited Impact of Delta Variant’s Mutations on the Effectiveness of Neutralization Conferred by Natural Infection or COVID-19 Vaccines in a Latino Population

“…At the beginning of the pandemic, most countries around the world underwent a strict lockdown that had serious social, economic and health service effects. As a consequence, many non-COVID-19 diseases, such as tuberculosis [3] and cancer [4], suffered delays in diagnosis and treatment, leading to more severe illness and outcomes.…”