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

The impact of the UK COVID-19 lockdown on the screening, diagnostics and incidence of breast, colorectal, lung and prostate cancer in the UK: a population-based cohort study

Introduction

The COVID-19 pandemic had collateral effects on many health systems. Cancer screening and diagnostic tests were postponed, resulting in delays in diagnosis and treatment. This study assessed the impact of the pandemic on screening, diagnostics and incidence of breast, colorectal, lung, and prostate cancer; and whether rates returned to pre-pandemic levels by December, 2021.

Methods

This is a cohort study of electronic health records from the United Kingdom (UK) primary care Clinical Practice Research Datalink (CPRD) GOLD database. The study included individuals registered with CPRD GOLD between January, 2017 and December, 2021, with at least 365 days of clinical history. The study focused on screening, diagnostic tests, referrals and diagnoses of first-ever breast, colorectal, lung, and prostate cancer. Incidence rates (IR) were stratified by age, sex, and region, and incidence rate ratios (IRR) were calculated to compare rates during and after lockdown with rates before lockdown. Forecasted rates were estimated using negative binomial regression models.

Results

Among 5,191,650 eligible participants, the first lockdown resulted in reduced screening and diagnostic tests for all cancers, which remained dramatically reduced across the whole observation period for almost all tests investigated. There were significant IRR reductions in breast (0.69 [95% CI: 0.63-0.74]), colorectal (0.74 [95% CI: 0.67-0.81]), and prostate (0.71 [95% CI: 0.66-0.78]) cancer diagnoses. IRR reductions for lung cancer were non-significant (0.92 [95% CI: 0.84-1.01]). Extrapolating to the entire UK population, an estimated 18,000 breast, 13,000 colorectal, 10,000 lung, and 21,000 prostate cancer diagnoses were missed from March, 2020 to December, 2021.

Discussion

The UK COVID-19 lockdown had a substantial impact on cancer screening, diagnostic tests, referrals, and diagnoses. Incidence rates remained significantly lower than pre-pandemic levels for breast and prostate cancers and associated tests by December, 2021. Delays in diagnosis are likely to have adverse consequences on cancer stage, treatment initiation, mortality rates, and years of life lost. Urgent strategies are needed to identify undiagnosed cases and address the long-term implications of delayed diagnoses.

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

Introduction

The COVID-19 pandemic has considerably affected healthcare systems worldwide and is expected to influence cancer incidence, mortality, stage at diagnosis, and survival. This study aimed to assess COVID-19-related changes in cancer incidence observed in 2020 in the Greater Poland region.

Materials and methods

Data from the Greater Poland Cancer Registry on cancer patients diagnosed between 2010 and 2020 were analysed. To quantify the change in the number of incident cancer cases during the COVID-19 pandemic, we calculated the standardized incidence ratio (SIR) and the incidence rate difference (IRD) to assume the pandemic-attributable gap in cancer incidence.

Results

In 2020, in Greater Poland, the expected number of new cancer cases was 18 154 (9 226 among males and 8 927 among females), while the observed number was 14 770 (7 336 among males and 7 434 among females). The registered number of cancer cases decreased in 2020 by 20% (SIR 0·80, 95% CI 0·78 to 0·81) and 17% (SIR 0·83, 95% CI 0·81 to 0·85) in males and females, respectively. Among men, the most significant difference was reported for myeloma (SIR 0·59, 95% CI 0·45 to 0·77), among women for bone cancer (SIR 0·47, 95% CI 0·20 to 0·93). In females the observed incidence was higher than expected for cancer of an unspecified site (SIR 1·19, 95% CI 1·01 to 1·38). In our study, the decrease in new cancer cases was greater in males than in females.

Discussion

The observed incidence was affected in most cancer sites, with the most significant deviation from the expected number in the case of myeloma. An increase in the observed incidence was reported only in women diagnosed with cancer of an unspecified site, which might reflect shortages in access to oncological diagnostics.

Impact of the COVID-19 pandemic on oncological care in Germany: rapid review

OBJECTIVES

The COVID-19 pandemic affected medical care for chronic diseases. This study aimed to systematically assess the pandemic impact on oncological care in Germany using a rapid review.

METHODS

MEDLINE, Embase, study and preprint registries and study bibliographies were searched for studies published between 2020 and 2 November 2022. Inclusion was based on the PCC framework: population (cancer), concept (oncological care) and context (COVID-19 pandemic in Germany). Studies were selected after title/abstract and full-text screening by two authors. Extracted data were synthesized using descriptive statistics or narratively. Risk of bias was assessed and summarized using descriptive statistics.

RESULTS

Overall, 77 records (59 peer-reviewed studies and 18 reports) with administrative, cancer registry and survey data were included. Disruptions in oncological care were reported and varied according to pandemic-related factors (e.g., pandemic stage) and other (non-pandemic) factors (e.g., care details). During higher restriction periods fewer consultations and non-urgent surgeries, and delayed diagnosis and screening were consistently reported. Heterogeneous results were reported for treatment types other than surgery (e.g., psychosocial care) and aftercare, while ongoing care remained mostly unchanged. The risk of bias was on average moderate.

CONCLUSIONS

Disruptions in oncological care were reported during the COVID-19 pandemic in Germany. Such disruptions probably depended on factors that were insufficiently controlled for in statistical analyses and evidence quality was on average only moderate. Research focus on patient outcomes (e.g., longer term consequences of disruptions) and pandemic management by healthcare systems is potentially relevant for future pandemics or health emergencies.

[Receptor tyrosine kinase- fusions in paediatric spindle cell tumors]

Pediatric spindle cell tumors are rare and often difficult to diagnose due to a similar morphology and a non-specific immunohistochemical profile. Genetic characterization of these lesions has been constantly improving, which has led to the identification of new subgroups that were partly included in the WHO classification. Receptor tyrosine kinase fusions play a special role in these tumors and their verification has diagnostic relevance and can be an option for target-oriented therapies. In the case of pediatric spindle cell tumors, genetic fusions form especially with NTRK1‑3, ALK, RET, and ROS1. Overall, pediatric tumors with receptor tyrosine kinase fusions are predominantly low-grade tumors, which are often subdivided into the group of intermediate-malign tumors.

Therapy delay due to COVID-19 pandemic among European women with breast cancer: prevalence and associated factors

PURPOSE

This study investigates the impact of the COVID-19 pandemic on breast cancer (BC) care, analyzing treatment delays and factors associated with them.

METHODS

This retrospective cross-sectional study analyzed data from the Oncology Dynamics (OD) database. Surveys of 26,933 women with BC performed between January 2021 and December 2022 in Germany, France, Italy, the United Kingdom, and Spain were examined. The study focused on determining the prevalence of treatment delays due to the COVID-19 pandemic, considering factors such as country, age group, treating facility, hormone receptor status, tumor stage, site of metastases, and Eastern Cooperative Oncology Group (ECOG) status. Baseline and clinical characteristics were compared for patients with and without therapy delay using chi-squared tests, and a multivariable logistic regression analysis was conducted to explore the association between demographic and clinical variables and therapy delay.

RESULTS

The present study found that most therapy delays lasted less than 3 months (2.4%). Factors associated with higher risk of delay included being bedridden (OR 3.62; 95% CI 2.51-5.21), receiving neoadjuvant therapy (OR 1.79; 95% CI 1.43-2.24) compared to adjuvant therapy, being treated in Italy (OR 1.58; 95% CI 1.17-2.15) compared to Germany or treatment in general hospitals and non-academic cancer facilities (OR 1.66, 95% CI 1.13-2.44 and OR 1.54; 95% CI 1.14-2.09, respectively) compared to treatment by office-based physicians.

CONCLUSION

Addressing factors associated with therapy delays, such as patient performance status, treatment settings, and geographic location, can help guide strategies for improved BC care delivery in the future.

How did the COVID-19 pandemic affect inpatient care for children in Germany? An exploratory analysis based on national hospital discharge data

BACKGROUND

The delivery of health services around the world faced considerable disruptions during the COVID-19 pandemic. While this has been discussed for a number of conditions in the adult population, related patterns have been studied less for children. In light of the detrimental effects of the pandemic, particularly for children and young people under the age of 18, it is pivotal to explore this issue further.

METHODS

Based on complete national hospital discharge data available via the German National Institute for the Reimbursement of Hospitals (InEK) data browser, we compare the top 30 diagnoses for which children were hospitalised in 2019, 2020, 2021 and 2022. We analyse the development of monthly admissions between January 2019 and December 2022 for three tracers of variable time-sensitivity: acute lymphoblastic leukaemia (ALL), appendicitis/appendectomy and tonsillectomy/adenoidectomy.

RESULTS

Compared to 2019, total admissions were approximately 20% lower in 2020 and 2021, and 13% lower in 2022. The composition of the most frequent principal diagnoses remained similar across years, although changes in rank were observed. Decreases were observed in 2020 for respiratory and gastrointestinal infections, with cases increasing again in 2021. The number of ALL admissions showed an upward trend and a periodicity prima vista unrelated to pandemic factors. Appendicitis admissions decreased by about 9% in 2020 and a further 8% in 2021 and 4% in 2022, while tonsillectomies/adenoidectomies decreased by more than 40% in 2020 and a further 32% in 2021 before increasing in 2022; for these tracers, monthly changes are in line with pandemic waves.

CONCLUSIONS

Hospital care for critical and urgent conditions among patients under the age of 18 was largely upheld in Germany during the COVID-19 pandemic, potentially at the expense of elective treatments. There is an alignment between observed variations in hospitalisations and pandemic mitigation measures, possibly also reflecting changes in demand. This study highlights the need for comprehensive, intersectoral data that would be necessary to better understand changing demand, unmet need/foregone care and shifts from inpatient to outpatient care, as well as their link to patient outcomes and health care efficiency.

Impact of the COVID-19 pandemic on paediatric renal tumour presentation and management, a SIOP renal tumour study group study

BACKGROUND

The COVID-19 pandemic had global catastrophic effects on the management of non-communicable diseases including paediatric cancers. Restrictions during the start of 2020 complicated timely referrals of patients to specialized centres. We aimed to evaluate the pandemic's impact on the number of new diagnoses, disease characteristics and management delay for paediatric renal tumour patients included in the SIOP-RTSG-UMBRELLA study, as compared with data from a historical SIOP-RTSG trial (2005-2009).

METHODS

The number of intensive care admissions, population mobility rates and national lockdown periods/restrictions were used as proxies of the pandemic's severity and impact on societies. Clinical and tumour data were extracted from the SIOP-RTSG-UMBRELLA study and from historical SIOP-RTSG trials.

RESULTS

During the first lockdown in Europe, the number of newly diagnosed patients decreased following restrictions and population immobilisation. Additionally, there was a higher proportion of advanced disease (37% vs. 17% before and after COVID-9, p < 0.001) and larger median tumour volume (559 cm3 vs. 328 and 434 cm3 before and after, p < 0.0001). Also in Brazil, the proportion of advanced disease was higher during the national decrease in mobilisation and start of restrictions (50% and 24% vs. 11% and 18% before and after, p < 0.01). Tumour volume in Brazil was also higher during the first months of COVID-19 (599 cm3 vs. 459 and 514 cm3 ), although not significant (p = 0.17). We did not observe any delays in referral time nor in time to start treatment, even though COVID-19 restrictions may have caused children to reach care later.

CONCLUSION

The COVID-19 pandemic briefly changed the tumour characteristics of children presenting with renal tumours. The longer-term impact on clinical outcomes will be kept under review.

Communication transforms the impact of the COVID-19 pandemic on children with cancer and their families

BACKGROUND

The COVID-19 pandemic altered healthcare systems globally, causing delays in care delivery and increased anxiety among patients and families. This study examined how hospital stakeholders and clinicians perceived the global impact of the COVID-19 pandemic on children with cancer and their families.

METHODS

This secondary analysis examined data from a qualitative study consisting of 19 focus groups conducted in 8 languages throughout 16 countries. A codebook was developed with novel codes derived inductively from transcript review. In-depth analysis focused on the impact of the COVID-19 pandemic on children with cancer and their families.

RESULTS

Eight themes describing the impact of the pandemic on patients and their families were identified and classified into three domains: contributing factors (COVID-19 Policies, Cancer Treatment Modifications, COVID-19 Symptoms, Beliefs), patient-related impacts (Quality of Care, Psychosocial impacts, Treatment Reluctance), and the central transformer (Communication). Participants described the ability of communication to transform the effect of contributing factors on patient-related impacts. The valence of impacts depended on the quality and quantity of communication among clinicians and between clinicians and patients and families.

CONCLUSIONS

Communication served as the central factor impacting whether the COVID-19 pandemic positively or negatively affected children with cancer and families. These findings emphasize the key role communication plays in delivering patient-centered care and can guide future development of communication-centered interventions globally.

Cancer care in German centers of excellence during the first 2 years of the COVID-19 pandemic

PURPOSE

An increasing number of international studies demonstrate serious negative effects of the COVID-19 pandemic on the timely diagnosis of cancer and on cancer treatment. Our study aimed to quantitatively and qualitatively evaluate the capacities of German Comprehensive Cancer Centers (CCCs) in different areas of complex oncology care during the first 2 years of the COVID-19 pandemic.

METHODS

Prospective panel survey over 23 rounds among 18 CCCs in Germany between March 2020 and June 2022.

RESULTS

The COVID-19 pandemic substantially affected the oncological care system in Germany during the first 2 years. Persistent limitations of care in CCCs primarily affected follow-up (- 21%) and psycho-oncologic care (- 12%), but also tumor surgery (- 9%). Substantial limitations were also reported for all other areas of multidisciplinary oncological care.

CONCLUSIONS

This study documents the limitations of oncological care during the COVID-19 pandemic and highlights the need to develop strategies to avoid similar limitations in the future.

Klimawandel und Kindergesundheit – Ein Aufruf zum Handeln

Der Klimawandel ist eine stille Krise und die größte Bedrohung unserer Zeit. Hitze, Extremwetterereignisse und Luftverschmutzung haben besondere Auswirkungen auf Frühgeburtlichkeit, akute und chronische Atemwegserkrankungen, Allergien und Asthma. Auch die Zunahme infektiöser Erkrankungen sowie eine erhöhte Exposition durch Karzinogene sowie deren Folgen werden beobachtet. Neben der Gefahr des Klimawandels für die somatische, hat die Krise auch Einfluss auf die mentale Gesundheit von Heranwachsenden und aggraviert das soziale Ungleichgewicht, wovon Kinder und Jugendliche in besonderer Weise betroffen sind.

Um die von Wissenschaftler:innen prognostizierten Szenarien abzuwenden, braucht es zum einen ein rasches und umfängliches Agieren der Politik, aber auch ein Neudenken unseres Selbstverständnisses als für Kinder- und Jugendgesundheit Verantwortliche sowie eine grundlegende Neuordnung von Prioritäten. Als Akteur:innen im Gesundheitswesen stehen wir besonders in der Verantwortung, uns für eine gesunde Erde einzusetzen. Dies kann und muss schon heute auf verschiedenen Ebenen, als Ärzt:innen, Wissenschaftler:innen, auf Ebenen der Patient:innenversorgung und der Fachgesellschaften erfolgen, um allen Kindern und Jugendlichen eine lebenswerte Zukunft zu ermöglichen.

Impact of the COVID-19 Pandemic on Gyne-Oncological Treatment-A Retrospective Single-Center Analysis of a German University Hospital with 30,525 Patients

The study pursues the objective of drawing a comparison between the data of gyne-oncology, gynecology, and obstetrics patient collectives of a German university hospital regarding the progression of patient number and corresponding treatment data during the five-year period of 2017-2021 to assess the impact of the COVID-19 pandemic on gyne-oncological treatment. Descriptive assessment is based on data extracted from the database of the hospital controlling system QlikView^® for patients hospitalized at the Department of Gynecology and Obstetrics of Marburg University Hospital. Gynecology and gyne-oncology experience a maintained decline in patient number (n_Gynecology: -6% 2019 to 2020, -5% 2019 to 2021; n_{Gyne-Oncology}: -6% 2019 to 2020, -2% 2019 to 2021) with varying effects on the specific gyne-oncological main diagnoses. Treatment parameters remain unchanged in relative assessment, but as gyne-oncology constitutes the dominating revenue contributor in gynecology (35.1% of patients, 52.9% of revenue, 2021), the extent of the decrease in total revenue (-18%, 2019 to 2020, -14%, 2019 to 2021) surpasses the decline in patient number. The study displays a negative impact on the gynecology care situation of a German university hospital for the entire pandemic, with an even greater extent on gyne-oncology. This development not only endangers the quality of medical service provision but collaterally pressurizes gynecology service providers.

Gesundheitsökonomischer Vergleich von onkologischen und COVID-19-Patienten

Zielsetzung Ziel der Studie ist es die Auswirkungen der COVID-19 Pandemie auf die stationär behandelten Patienten eines universitären Maximalversorgers mit einer Krebs- und/oder COVID-19-Erkrankung zu untersuchen. Unterscheiden sich die Patientenkollektive gesundheitsökonomisch und ergeben sich aus den Resultaten administrative Konsequenzen für eine proaktive Steuerung der regionalen Krebsversorgung.

Methodik Es wurde eine retrospektive, deskriptive Datenanalyse klinischer und gesundheitsökonomischer Parameter aller am Universitätsklinikum Marburg stationär aufgenommenen onkologischen und COVID-19-postiven Patienten sowie der Kombination von onkologischen Patienten mit einer COVID-19-Erkrankung innerhalb des Beobachtungszeitraums von 2017 bis 2021 durchgeführt.

Ergebnisse Es wurde ein Rückgang onkologisch behandelter Patienten über den gesamten Zeitraum der COVID-19-Pandemie beobachtet. Onkologische Patienten mit einer COVID-19-Erkrankung stellen das Patientenkollektiv mit dem höchsten Schweregrad der Erkrankung dar, gefolgt von der COVID-19- und rein onkologischen Patienten. Dies spiegelt sich gleichsam in den ökonomischen Leistungskennzahlen wider. Die chronologischen Verläufe des DRG-Erlöses und Case Mix Index pro COVID-19-Patienten weisen Unterschiede für Zeitabschnitte des Pandemiegeschehens in Deutschland auf.

Schlussfolgerung Der Vergleich der Patientenkollektive bestätigt das hohes Gefährdungspotential von onkologischen Patienten, welches sich in einer gesundheitsökonomisch aufwendigen Behandlung widerspiegelt. Nationale Maßnahmen, Kontaktbeschränkungen oder pandemische Ereignisse lassen sich am chronologischen Verlauf der klinischen und wirtschaftlichen Parameter nachvollziehen. Trotz des internationalen Rückgangs an ambulanten und stationären onkologischen Patienten ist die „state-of-the-art“ Krebsversorgung in pandemischen Zeiten realisierbar. Aufgrund dessen besteht die Handlungsnotwendigkeit für einen stationären Maximalversorger durch Kommunikation und Versorgungsmodellierung die onkologische Versorgung proaktiver zu steuern.

'Never once was I thinking the c-word': Parent perspectives on the facilitators and barriers to getting a childhood cancer diagnosis

AIMS AND OBJECTIVES

To describe the facilitators and barriers of getting from 'something's not right' to a childhood cancer diagnosis from the perspective of parents living in the United States of America.

BACKGROUND

It is common for families to experience long trajectories from when they first notice symptoms to receiving a childhood cancer diagnosis. Understanding this trajectory within the social and cultural contexts of the United States healthcare system is the first step in developing strategies for reducing this timeframe and mitigating some of the psychosocial impact for parents in receiving a childhood cancer diagnosis. This study examines the interpretations and meanings parents attributed to their child's symptoms, their decisions regarding seeking medical care, interactions with healthcare providers and the time course of events.

DESIGN

An inductive qualitative inquiry.

METHODS

In-depth, semi-structured interviews with 55 participants representing 39 unique cases of childhood cancer were conducted. Data were analysed using an inductive thematic approach. COREQ guidelines were followed.

RESULTS

Participants described multiple barriers and facilitators in their path to receiving a childhood cancer diagnosis. Facilitators included noticing something 'wasn't right' and physician in agreement that symptoms were unusual; acute symptoms requiring action; advocating for a diagnosis; and obtaining a second opinion. Barriers included parents having to interpret symptoms in the context of daily life; physician dismissiveness even when symptoms persisted; and not feeling they could question their physician's assessment.

CONCLUSION

Families experience multiple facilitators and barriers in their trajectory to receiving a childhood cancer diagnosis.

RELEVANCE TO CLINICAL PRACTICE

Understanding the path to diagnosis from the parent perspective may increase opportunities for shared decision-making. Clinician educational modules that include family perspectives may improve patient/parent-provider relationships.

PARTICIPANT CONTRIBUTION

Participants described their family's cancer journey through narrative storytelling. Participants had the opportunity to review and make edits to their transcript.

The impact of COVID-19 on presentation and diagnosis of head and neck squamous cell carcinoma

Objective

To analyze how the COVID-19 pandemic has influenced trends in head and neck squamous cell carcinoma (HNSCC) presentation and diagnosis-including referral patterns, stage at presentation, and time to diagnosis-over a longitudinal time course.

Setting

Multicenter tertiary care academic institution.

Methods

A retrospective review of patients with HNSCC presenting between January 1, 2019 and December 31, 2020 was performed. Patients were stratified into pre-COVID and COVID cohorts based upon presentation date either before or after the COVID pandemic was declared a national emergency. Data was collected on demographics, referral site, symptoms, tumor characteristics, and time to diagnosis.

Results

Of 203 patients with HNSCC identified, 77.3% (157/203) were in the pre-COVID cohort and 22.7% (46/203) were in the COVID cohort. Patients in the COVID cohort were more likely to present through inpatient or ER consultation (26% vs. 11%) than outpatient setting. There was a greater than 50% decrease in new tumor board case presentations per month in the COVID cohort (4.8) relative to the pre-COVID (10.9) cohort. Cancer stage at presentation was similar between cohorts. Time from presentation to diagnosis was similar between the cohorts at approximately 30 days.

Conclusions

These results suggest that patients presenting during the COVID pandemic may have unique referral patterns. A significant decrease in tumor board presentations was noted, which may contribute to more delayed presentations that have yet to be observed. Further investigation with a larger sample size is warranted.

Lay Summary

The COVID-19 pandemic may have changed where and how patients with head and neck cancer initially seek care. We found that patients with newly diagnosed head and neck cancer more often were initially seen in urgent settings than before the pandemic.

Level of Evidence

3.

Lessons Learned from the Surgical Management of Childhood Cancers During the COVID-19 Pandemic

Globally, there have been more than 285 million confirmed cases of coronavirus disease 2019 (COVID-19), with nearly 5.5 million deaths. Centers for Disease Control and Prevention data report that in the United States alone, there have been more than 59 million cases of COVID-19 with more than 800,000 lives lost as of January 2022. Similar to other health care specialties, pediatric surgery departments have modified their treatment approach to delivering timely care while respecting resource allocation during the pandemic. In this review, we focus on the surgical management of pediatric patients, with specific attention to childhood cancer. The primary subject of this review is the development of triaging methods for patients with childhood cancer for surgical procedures and precautionary measures for operating on patients with COVID-19. [Pediatr Ann. 2022;51():e270-e276.].

Chronological development of in-patient oncology in times of COVID-19: a retrospective analysis of hospitalized oncology and COVID-19 patients of a German University Hospital

Purpose

The goal of this study is to examine the chronological development of hospitalized oncology and COVID-19 patients, and compare effects on oncology sub-disciplines for pre-pandemic (2017–19) and pandemic (2020–21) years in the setting of a German university maximum care provider.

Methods

Data were retrospectively retrieved from the hospital performance controlling system for patient collectives with oncological main (n_Onco) and COVID-19 secondary diagnosis (n_COVID-19). Data analysis is based on descriptive statistical assessment.

Results

The oncology patient collective (n_Onco = 27,919) shows a decrease of hospitalized patients for the whole pandemic (− 4% for 2020 and − 2,5% for 2021 to 2019). The number of hospitalized COVID-19 patients increases from first to second pandemic year by + 106.71% (n_COVID-19 = 868). Maximum decline in monthly hospitalized oncology patients amounts to − 19% (May 2020) during the first and − 21% (December 2020) during the second lockdown. Relative monthly hospitalization levels of oncology patients reverted to pre-pandemic levels from February 2021 onwards.

Conclusion

The results confirm a decline in hospitalized oncology patients for the entire pandemic in the setting of a maximum care provider. Imposed lockdown and contact restrictions, rising COVID-19 case numbers, as well as discovery of new virus variants have a negative impact on hospitalized treated oncological patients.

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

Purpose

Little is known on how coronavirus disease 2019 (COVID-19) has impacted cancer diagnosis in Germany since the first lockdown in March 2020. Therefore, this retrospective study aimed to compare the number of patients newly diagnosed with cancer in general and specialized practices in Germany between April 2020–March 2021 and April 2019–March 2020.

Methods

Patients aged ≥ 18 years with at least 1 visit to 1 of 1403 general and specialized practices in Germany in April 2020–March 2021 (n = 3,804,596) and April 2019–March 2020 (n = 3,913,386) were included in this retrospective study. Specialized practices were composed of gynecology, dermatology and urology practices. Cancer diagnoses included all types of cancer documented using the International Classification of Diseases, 10th revision (ICD-10 codes: C00-C97). The number of patients newly diagnosed with cancer per practice was compared between April 2020–March 2021 and April 2019–March 2020 using Wilcoxon tests.

Results

There were 126,379 and 138,996 patients diagnosed with cancer in April 2020–March 2021 and April 2019–March 2020, respectively. The number of patients diagnosed with cancer decreased in all types of practice, and this decrease was significant in general practices (− 7.1%, p value = 0.038). In terms of cancer type, this decrease was particularly pronounced for skin cancers (− 12.8%, p value = 0.025).

Conclusion

The COVID-19 pandemic has been associated with a decrease in the number of patients newly diagnosed with cancer in general and specialized practices in Germany. Public health interventions are urgently warranted to mitigate the deleterious effects of this health crisis on cancer diagnosis.

Kapazität der onkologischen Versorgung in deutschen onkologischen Spitzenzentren während der ersten 2 Jahre der COVID-19-Pandemie

Hintergrund

Eine zunehmende Zahl von internationalen Studien zeigt, dass die COVID-19-Pandemie schwerwiegende negative Auswirkungen auf die rechtzeitige Diagnose von Krebs und auf die Krebsbehandlung hat.

Ziel der Arbeit

Ziel der Arbeit war die quantitative und qualitative Auswertung der Kapazitäten deutscher onkologischer Spitzenzentren (Comprehensive Cancer Centers, CCCs) in verschiedenen Bereichen der komplexen onkologischen Versorgung im Zeitraum März 2020 bis Juni 2022.

Material und Methoden

Unter 18 CCCs in Deutschland erfolgte zwischen März 2020 und Juni 2022 eine prospektive regelmäßige Panelerhebung.

Ergebnisse

Die COVID-19-Pandemie hat in den ersten beiden Jahren das onkologische Versorgungssystem in Deutschland substanziell beeinträchtigt. Anhaltende Einschränkungen der Versorgung in den CCCs betrafen in erster Linie die Nachsorge (−21 %) und die Psychoonkologie (−12 %), aber auch Tumoroperationen (−9 %). Deutliche Funktions- und Kapazitätseinschränkungen fanden sich ebenso in allen weiteren Bereichen der multidisziplinären onkologischen Betreuung.

Diskussion

Die Studie dokumentiert die eingeschränkte onkologische Versorgung der Bevölkerung während der COVID-19-Pandemie. Die Auswirkungen lassen sich noch nicht vollumfänglich darstellen. Dennoch müssen (jetzt) Strategien zur Vermeidung solcher Einschränkungen entwickelt werden.

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

The SARS-CoV-2 pandemic has impacted public health systems all over the world. The Delta variant seems to possess enhanced transmissibility, but no clear evidence suggests it has increased virulence. Our data show that pre-exposed individuals had similar neutralizing activity against the authentic COVID-19 strain and the Delta and Epsilon variants. After only one vaccine dose, the neutralization capacity expanded to all tested variants in pre-exposed individuals. Healthy vaccinated individuals showed a limited breadth of neutralization. One vaccine dose did induce similar neutralizing antibodies against the Delta as against the authentic strain. However, even after two doses, this capacity only expanded to the Epsilon variant.

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

Several coronaviruses (CoVs) have been associated with serious health hazards in recent decades, resulting in the deaths of thousands around the globe. The recent coronavirus pandemic has emphasized the importance of discovering novel and effective antiviral medicines as quickly as possible to prevent more loss of human lives. Positive-sense RNA viruses with group spikes protruding from their surfaces and an abnormally large RNA genome enclose CoVs. CoVs have already been related to a range of respiratory infectious diseases possibly fatal to humans, such as MERS, SARS, and the current COVID-19 outbreak. As a result, effective prevention, treatment, and medications against human coronavirus (HCoV) is urgently needed. In recent years, many natural substances have been discovered with a variety of biological significance, including antiviral properties. Throughout this work, we reviewed a wide range of natural substances that interrupt the life cycles for MERS and SARS, as well as their potential application in the treatment of COVID-19.