Impact of the COVID-19 pandemic on diagnosis, stage, and initial treatment of breast cancer in the Netherlands: a population-based study

Abstract

Background The onset of the COVID-19 pandemic forced the Dutch national screening program to a halt and increased the burden on health care services, necessitating the introduction of specific breast cancer treatment recommendations from week 12 of 2020. We aimed to investigate the impact of COVID-19 on the diagnosis, stage and initial treatment of breast cancer. Methods Women included in the Netherlands Cancer Registry and diagnosed during four periods in weeks 2–17 of 2020 were compared with reference data from 2018/2019 (averaged). Weekly incidence was calculated by age group and tumor stage. The number of women receiving initial treatment within 3 months of diagnosis was calculated by period, initial treatment, age, and stage. Initial treatment, stratified by tumor behavior (ductal carcinoma in situ [DCIS] or invasive), was analyzed by logistic regression and adjusted for age, socioeconomic status, stage, subtype, and region. Factors influencing time to treatment were analyzed by Cox regression. Results Incidence declined across all age groups and tumor stages (except stage IV) from 2018/2019 to 2020, particularly for DCIS and stage I disease (p < 0.05). DCIS was less likely to be treated within 3 months (odds ratio [OR]wks2–8: 2.04, ORwks9–11: 2.18). Invasive tumors were less likely to be treated initially by mastectomy with immediate reconstruction (ORwks12–13: 0.52) or by breast conserving surgery (ORwks14–17: 0.75). Chemotherapy was less likely for tumors diagnosed in the beginning of the study period (ORwks9–11: 0.59, ORwks12–13: 0.66), but more likely for those diagnosed at the end (ORwks14–17: 1.31). Primary hormonal treatment was more common (ORwks2–8: 1.23, ORwks9–11: 1.92, ORwks12–13: 3.01). Only women diagnosed in weeks 2–8 of 2020 experienced treatment delays. Conclusion The incidence of breast cancer fell in early 2020, and treatment approaches adapted rapidly. Clarification is needed on how this has affected stage migration and outcomes.

What Has Changed During the COVID-19 Pandemic? - The Effect on an Academic Breast Department in Portugal

“…However, the incidence of stage IV tumors did not decline. As the incidence reduction mainly occurred for the lowest stage disease, the authors suggested that the delay in diagnosis would not have had a large impact on long-term outcomes (20). A multicentric analysis from Italy, reporting the effects in the first three months after lockdown, showed a significant difference in waiting times, proportion of patients with lymph-node involvement, and cancer grading, compared with the similar period from the previous year.…”

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

“…Previous works addressed the impact of the COVID-19 pandemic on regional or national settings [5, 50], on specific cancers [5,6,169], specific stages of the care pathway [54], or treatment modalities [22]. This scoping review provides a summary of cancer care performance indicators, concerning various diseases, from early detection to the treatment phase of the care pathway, within OECD countries.…”

“…The COVID-19 pandemic has widely affected cancer care delivery. Substantial declines in the number of cancer diagnoses have been reported in the Netherlands [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 [10–12].…”

The impact of the COVID-19 pandemic on perceived access to health care and preferences for health care provision in individuals (being) treated for breast cancer

“…In line with this, Eijkelboom and colleagues observed a decrease in breast cancer incidences across all age groups during the first month of the COVID-19 pandemic in the Netherlands [ 4 ]. In addition to the halt of the Dutch national breast cancer screening program, the increased reluctance of patients to visit their general practitioner along with the advice to vulnerable individuals to stay at home in the first month of the pandemic might have contributed to this decrease in breast cancer incidence during the pandemic [ 6 ].…”

“…In the Netherlands, the incidence of breast cancer diagnoses fell with approximately 35% during the first months of the COVID-19 pandemic [ 5 , 6 ]. Moreover, one in three patients reported changes in their cancer care and increased concerns about the consequences of the delay in treatment and perceived barriers in access to health care were observed [ 3 , 7 , 8 ].…”