Article
Evidence synthesis on diagnostic stages, treatment outcomes and healthcare use in individuals with cancer during the COVID-19 pandemic in Germany to support an agent-based model
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Authors
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Nina Overhageböck
- Department for Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany; Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
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Janine Ropeter
- Department for Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany; Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
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Manuela Harries
- Department for Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
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Carolina J. Klett-Tammen
- Department for Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
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Torben Heinsohn
- Department for Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
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Maren Steinmann
- Department of Health Economics and Health Care Management, Bielefeld University, Bielefeld, Germany
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Alexander Kuhlmann
- Faculty of Medicine, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany; German Center for Lung Research (DZL), Biomedical Research in End-Stage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
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Beate Jahn
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Technology, Hall in Tirol, Austria
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Maren Dreier
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
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Berit Lange
- Department for Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany; German Center for Infection Research (DZIF), Translational Infrastructure Bioresources, Biodata and Digital Health, Braunschweig, Germany
| Published: | September 6, 2024 |
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Outline
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Introduction: During the COVID-19 pandemic, we have seen changes in the diagnosis and treatment of people with chronical conditions including people with cancer. Screening services for cancer were reduced or completely shut down during lockdown periods and treatment - especially operations - were postponed or changed if possible. This and other non-pharmaceutical interventions (NPIs) may have affected new cancer diagnoses, cancer stage at diagnosis, changes or delay in treatment (e.g. operations or chemotherapies), and the healthcare use of this vulnerable target group. Quantitative estimates of collateral effect of NPIs are needed for epidemiological modelling supporting decision making during future pandemics or other disruptive events. We conducted a systematic review to summarize the existing evidence in the German context.
Methods: Electronic databases PubMed, Embase, Scopus, Web of Science and Cochrane Library were systematically searched on 15 January – 28 February 2024 for relevant publications. Inclusion criteria were assessment of change in diagnosis, incidence, disease-specific mortality, diagnostic stages, treatment outcome, and healthcare use in patients with cancer of the types with the highest number of deaths in Germany (breast, lung, pancreatic) during the COVID-19 pandemic. We incorporated studies conducted in Germany. Two reviewers performed screening, extraction, and risk of bias assessment independently. The ROBINS-E tool is used for risk of bias assessment. Evidence tables are developed to synthesize relevant information.
Results: Of initially 4.397 studies, we removed duplicates and included 1.991 in the screening process. After title and abstract screening, 130 publications were screened for full text and 23 met the inclusion criteria. Thirteen studies discuss the situation in all of Germany, five the situation in a specific federal state and six the situation in a specific city. Six studies refer to the situation in different German hospitals and two to the situation in practices. The studies address breast cancer (n=15), lung cancer (n=13), and pancreatic cancer (n=3). The included Studies focus on changes in the number of newly diagnosed cancer cases including changes in diagnostic stages (n=16), changes or delays in treatment or operation (n=9), and inpatient and outpatient healthcare use of patients (n=3). There is no data regarding the healthcare use of people with pancreatic cancer.
Conclusion: There is evidence to inform about the changes in diagnostic stages, treatment outcome and healthcare use of people with cancer during the COVID-19 pandemic. To inform a German-based agent-based model, we will complete the existing international synthesized evidence on collateral effects from a previous umbrella review with the existing data in the German context.
The authors declare that they have no competing interests.
The authors declare that an ethics committee vote is not required.
