Article
Comparison of and trends in incidence and mortality for colorectal and pancreatic cancer, coronary heart disease, and type-2 diabetes between 2017 and 2020 – impacts of the COVID-19 pandemic
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Published: | September 30, 2022 |
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Background and status of (inter)national research: The impact of the COVID-19 pandemic on the diagnosis, treatment and outcome of colorectal and pancreatic cancer compared to non-cancer entities, has been a focus of the CancerCOVID project, funded by the federal ministry for education and research (funding # 01KI20521A-C). Systematic reviews of the international literature indicate that the number of colorectal cancer screenings and diagnoses decreased during 20201, 2.
Research question and objective: The subproject “health care research” aimed to describe the impact of the COVID-19 pandemic on incidence and mortality for colorectal and pancreatic cancer in comparison with two non-cancer entities (coronary heart disease (CHD) and type-2 diabetes (T2D)) based on analyses of routine health care data. Trend analyses for and comparisons of the years 2017-2019 (pre-pandemic) with 2020 (first and second wave of the pandemic in Saxony, Germany) were carried out.
Method or hypothesis: The analyses were based on 2015–2020 claims data submitted to the AOK PLUS Sachsen, the health insurance provider for about 50% of the population in Saxony. Age-standardized incidence and mortality rates (EU2013) were computed.
Results: A decrease in diagnosed incident colorectal (minus approx. 25%), but not of pancreatic cancer, was observed for 2020 in comparison to the previous years. A decrease in diagnosed incidence was also observed for T2D and CHD as compared to 2019 (minus approx. 45% and 14%, resp.). Mortality rates did not change substantially for the two cancer entities in 2020 as compared to the earlier years. However, mortality for T2D und CHD increased in 2020 (plus approx. 7 and 3%, resp.), especially during the fourth quarter.
Discussion: The decreased capture of incident colorectal cancer cases has to be interpreted as a delay in the tumor diagnosis with possible adverse impact on patient prognosis. To observe potential resulting mortality impacts of reduced health services provision or demand during the pandemic (e.g., late diagnosis and delayed treatments) for the cancer entities a longer follow-up is needed (at least data for 2021/22). Systematic reviews3, 4 indicate that delay of surgery (e.g., elective resection) in colorectal cancer beyond 12 weeks may decrease overall survival.
Practical implications: Even during the first wave of the pandemic which was rather mild in the study region (Saxony), adverse impact on the diagnosis of colorectal cancer was observed based on administrative healthcare data. As a pandemic preparedness implication, an infrastructure should be implemented to monitor the healthcare provision for vulnerable populations and diseases in which early detection and treatment is highly relevant. As a possible clinical implication of this study, physicians and patients should be advised not to postpone diagnosis and treatment of suspected cancer, even in crises such as the COVID-19 pandemic.
Appeal for practice (science and/or care) in one sentence: It has been hypothesized that the reduced health services provision and/or demand during the pandemic will have long-term impacts on cancer mortality – an analysis of data for 2021/2022 and possibly subsequent years is warranted to validly investigate this claim.
Funding: Einzelförderung (BMG, DRV, BMBF, DFG, etc); BMBF-Förderkennzeichen: 01KI20521A-C