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De Santis KK, Helmer S, Barnes B, Kraywinkel K, Imhoff M, Müller-Eberstein R, Kirstein M, Quatmann A, Simke J, Stiens L, Christianson L, Zeeb H. Impact of the COVID-19 pandemic on oncological care in Germany: rapid review. J Cancer Res Clin Oncol 2023; 149:14329-14340. [PMID: 37507594 PMCID: PMC10590309 DOI: 10.1007/s00432-023-05063-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 06/29/2023] [Indexed: 07/30/2023]
Abstract
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.
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Affiliation(s)
- Karina Karolina De Santis
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology- BIPS, Bremen, Germany.
| | - Stefanie Helmer
- Faculty 11 Human and Health Sciences, University of Bremen, Bremen, Germany
| | - Benjamin Barnes
- German Center for Cancer Registry Data, Robert Koch Institute (RKI), Berlin, Germany
| | - Klaus Kraywinkel
- German Center for Cancer Registry Data, Robert Koch Institute (RKI), Berlin, Germany
| | - Maren Imhoff
- German Center for Cancer Registry Data, Robert Koch Institute (RKI), Berlin, Germany
| | | | - Mathia Kirstein
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology- BIPS, Bremen, Germany
| | - Anna Quatmann
- Faculty 11 Human and Health Sciences, University of Bremen, Bremen, Germany
| | - Julia Simke
- Faculty 11 Human and Health Sciences, University of Bremen, Bremen, Germany
| | - Lisa Stiens
- Faculty 11 Human and Health Sciences, University of Bremen, Bremen, Germany
| | - Lara Christianson
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology- BIPS, Bremen, Germany
| | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology- BIPS, Bremen, Germany
- Faculty 11 Human and Health Sciences, University of Bremen, Bremen, Germany
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2
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Voigtländer S, Hakimhashemi A, Grundmann N, Radespiel-Tröger M, Inwald EC, Ortmann O, Gerken M, Klug SJ, Klinkhammer-Schalke M, Meyer M, Müller-Nordhorn J. Impact of the COVID-19 pandemic on reported cancer diagnoses in Bavaria, Germany. J Cancer Res Clin Oncol 2023; 149:7493-7503. [PMID: 36964405 PMCID: PMC10038367 DOI: 10.1007/s00432-023-04707-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/17/2023] [Indexed: 03/26/2023]
Abstract
PURPOSE The aim of our study was to explore the impact of the COVID-19 pandemic on reported cancer cases in Bavaria, Germany, by comparing pre-pandemic (March 2019 to February 2020) and pandemic period (March 2020 to February 2021). METHODS Data on incident cases were retrieved from the Bavarian Cancer Registry (until 22nd April 2022). We included patients with malignant and in situ neoplasms reported by pathology departments with consistent reporting. We calculated the number of incident cases during the COVID-19 pandemic and the pre-pandemic period with 95% confidence intervals (CI) with Bonferroni correction (α = 0.0018) based on a Poisson approach. We stratified for malignancy (malignant, in situ), tumor site, and month of year. RESULTS Data was available for 30 out of 58 pathology departments (51.7%) from Bavaria. Incident malignant neoplasms dropped from 42,857 cases in the pre-pandemic period to 39,980 cases in the pandemic period (- 6.7%; 95% CI - 8.7%, - 4.7%). Reductions were higher for colon, rectum, skin/melanoma as well as liver (> 10.0% reduction) and less for breast cancer (4.9% reduction). No case reductions were observed for pancreas, esophagus, ovary, and cervix. Percent changes were largest for April 2020 (- 20.9%; 95% CI - 24.7%, - 16.8%) and January 2021 (- 25.2%; 95% CI - 28.8%, - 21.5%) compared to the previous year. Declines tended to be larger for in situ compared to malignant neoplasms. CONCLUSION Detection and diagnosis of cancer were substantially reduced during the COVID-19 pandemic. Potential effects, e.g. a stage shift of tumors or an increase of cancer mortality, need to be monitored.
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Affiliation(s)
- Sven Voigtländer
- Bavarian Cancer Registry, Bavarian Health and Food Safety Authority, Schweinauer Hauptstraße 80, 90441 Nuremberg, Germany
| | - Amir Hakimhashemi
- Bavarian Cancer Registry, Bavarian Health and Food Safety Authority, Schweinauer Hauptstraße 80, 90441 Nuremberg, Germany
| | - Nina Grundmann
- Bavarian Cancer Registry, Bavarian Health and Food Safety Authority, Schweinauer Hauptstraße 80, 90441 Nuremberg, Germany
| | - Martin Radespiel-Tröger
- Bavarian Cancer Registry, Bavarian Health and Food Safety Authority, Schweinauer Hauptstraße 80, 90441 Nuremberg, Germany
| | - Elisabeth C. Inwald
- Department of Gynecology and Obstetrics, University Medical Center, Landshuter Straße 65, 93053 Regensburg, Germany
| | - Olaf Ortmann
- Department of Gynecology and Obstetrics, University Medical Center, Landshuter Straße 65, 93053 Regensburg, Germany
| | - Michael Gerken
- Institute for Quality Assurance and Health Services Research, University of Regensburg, Am BioPark 9, 93053 Regensburg, Germany
| | - Stefanie J. Klug
- Chair of Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Georg-Brauchle-Ring 56, 80992 Munich, Germany
| | - Monika Klinkhammer-Schalke
- Institute for Quality Assurance and Health Services Research, University of Regensburg, Am BioPark 9, 93053 Regensburg, Germany
| | - Martin Meyer
- Bavarian Cancer Registry, Bavarian Health and Food Safety Authority, Schweinauer Hauptstraße 80, 90441 Nuremberg, Germany
| | - Jacqueline Müller-Nordhorn
- Bavarian Cancer Registry, Bavarian Health and Food Safety Authority, Schweinauer Hauptstraße 80, 90441 Nuremberg, Germany
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Griewing S, Lingenfelder M, Kalder M, Wagner U, Gremke N. Gesundheitsökonomischer Vergleich von onkologischen und
COVID-19-Patienten. GESUNDHEITSÖKONOMIE & QUALITÄTSMANAGEMENT 2022. [DOI: 10.1055/a-1945-6672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Zusammenfassung
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.
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Affiliation(s)
- Sebastian Griewing
- Institut für Health Care Management e.V., Lehrstuhl für
Allgemeine Betriebswirtschaftslehre, Philipps-Universität Marburg,
Marburg, Germany
- Klinik für Gynäkologie und Geburtshilfe,
Universitätsklinikum Marburg, Philipps-Universität Marburg,
Marburg, Germany
| | - Michael Lingenfelder
- Institut für Health Care Management e.V., Lehrstuhl für
Allgemeine Betriebswirtschaftslehre, Philipps-Universität Marburg,
Marburg, Germany
| | - Matthias Kalder
- Klinik für Gynäkologie und Geburtshilfe,
Universitätsklinikum Marburg, Philipps-Universität Marburg,
Marburg, Germany
| | - Uwe Wagner
- Klinik für Gynäkologie und Geburtshilfe,
Universitätsklinikum Marburg, Philipps-Universität Marburg,
Marburg, Germany
| | - Niklas Gremke
- Klinik für Gynäkologie und Geburtshilfe,
Universitätsklinikum Marburg, Philipps-Universität Marburg,
Marburg, Germany
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Jacob L, Kalder M, Kostev K. Decrease in the number of patients diagnosed with cancer during the COVID-19 pandemic in Germany. J Cancer Res Clin Oncol 2022; 148:3117-3123. [PMID: 35041059 PMCID: PMC8764247 DOI: 10.1007/s00432-022-03922-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 01/11/2022] [Indexed: 12/17/2022]
Abstract
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.
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Affiliation(s)
- Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu/CIBERSAM, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona, Spain
- Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, 78180, Montigny-le-Bretonneux, France
| | - Matthias Kalder
- Department of Gynecology and Obstetrics, Philipps University of Marburg, 35037, Marburg, Germany
| | - Karel Kostev
- Department of Epidemiology, IQVIA, Unterschweinstiege 2-14, 60549, Frankfurt am Main, Germany.
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Griewing S, Wagner U, Lingenfelder M, Fischer R, Kalder M. 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. J Cancer Res Clin Oncol 2022; 149:2551-2558. [PMID: 35771262 PMCID: PMC9244885 DOI: 10.1007/s00432-022-04044-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/26/2022] [Indexed: 11/19/2022]
Abstract
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 (nOnco) and COVID-19 secondary diagnosis (nCOVID-19). Data analysis is based on descriptive statistical assessment. Results The oncology patient collective (nOnco = 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% (nCOVID-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.
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Affiliation(s)
- Sebastian Griewing
- Department of Gynecology and Obstetrics, University Hospital Marburg, Philipps-University Marburg, Baldingerstraße, 35043, Marburg, Germany. .,Chair of General Business Administration, Institute for Health Care Management e.V., Philipps-University Marburg, Universitätsstraße 24, 35037, Marburg, Germany.
| | - Uwe Wagner
- Department of Gynecology and Obstetrics, University Hospital Marburg, Philipps-University Marburg, Baldingerstraße, 35043, Marburg, Germany
| | - Michael Lingenfelder
- Chair of General Business Administration, Institute for Health Care Management e.V., Philipps-University Marburg, Universitätsstraße 24, 35037, Marburg, Germany
| | - Rebecca Fischer
- Department of Gynecology and Obstetrics, University Hospital Marburg, Philipps-University Marburg, Baldingerstraße, 35043, Marburg, Germany
| | - Matthias Kalder
- Department of Gynecology and Obstetrics, University Hospital Marburg, Philipps-University Marburg, Baldingerstraße, 35043, Marburg, Germany
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Hermes-Moll K, Walawgo T, Richter M, Osburg S, Hempler I, Blattert L, Becker J, Heidt V. Umfrage unter hämatoonkologischen Schwerpunktpraxen zur COVID-19-Lage. INFO HÄMATOLOGIE + ONKOLOGIE 2021. [PMCID: PMC8437579 DOI: 10.1007/s15004-021-8784-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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7
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Piontek D, Klagges S, Schubotz B, Werner C, Wulff J. Documented New Cases of Cancer in the Clinical Cancer Registries of the German State of Saxony During the COVID-19 Pandemic. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:328-329. [PMID: 34140084 DOI: 10.3238/arztebl.m2021.0216] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 03/17/2021] [Accepted: 04/16/2021] [Indexed: 11/27/2022]
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Heimes D, Müller LK, Schellin A, Naujokat H, Graetz C, Schwendicke F, Goedecke M, Beck-Broichsitter B, Kämmerer PW. Consequences of the COVID-19 Pandemic and Governmental Containment Policies on the Detection and Therapy of Oral Malignant Lesions-A Retrospective, Multicenter Cohort Study from Germany. Cancers (Basel) 2021; 13:2892. [PMID: 34207863 PMCID: PMC8227890 DOI: 10.3390/cancers13122892] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/04/2021] [Accepted: 06/06/2021] [Indexed: 12/23/2022] Open
Abstract
(1) Background: In response to the global COVID-19 pandemic, governmental measures have been undertaken. The impact of the crisis on the healthcare of patients with cancer is largely unexplored. This multicenter cohort study aimed to investigate a potential screening delay and its consequences in patients with oral cancer (OC) during the pandemic. (2) Material and Methods: Data of patients who were first diagnosed with OC during different periods were collected, especially in terms of OC incidence, tumor stage/entity and time to intervention. The periods lockdown (LD) (13 March-16 June 2020), post-lockdown (PLD) (17 June-1 November 2020), and the corresponding equivalents in 2018/19 were differentiated and compared. (3) Results: There was no obvious trend towards a higher incidence of OC or higher tumor stages, whereas a trend towards a shorter time to intervention during the LD2020 could be observed. Subgroup analyses revealed an increased incidence in OC within the PLD2020 in Mainz, which might be explained by the partial closure of dental practices in this federal state during LD. (4) Conclusions: While there was no overall higher incidence of OC, we found closure of practices during LD to possibly delay cancer diagnosis. Therefore, measures must be taken to identify patients at risk and to ensure basic healthcare, especially in the context of dental screening measures.
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Affiliation(s)
- Diana Heimes
- Department of Oral- and Maxillofacial Surgery, University Medical Center Mainz, Augustusplatz 2, 55131 Mainz, Germany; (L.K.M.); (P.W.K.)
| | - Lena Katharina Müller
- Department of Oral- and Maxillofacial Surgery, University Medical Center Mainz, Augustusplatz 2, 55131 Mainz, Germany; (L.K.M.); (P.W.K.)
| | - Alexandra Schellin
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, 24105 Kiel, Germany; (A.S.); (H.N.)
| | - Hendrik Naujokat
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, 24105 Kiel, Germany; (A.S.); (H.N.)
| | - Christian Graetz
- Clinic for Conservative Dentistry and Periodontology, School of Dental Medicine, Christian-Albrechts-University of Kiel, 24118 Kiel, Germany;
| | - Falk Schwendicke
- Department of Operative and Preventive Dentistry, Charité University of Berlin, 10117 Berlin, Germany;
| | - Maximilian Goedecke
- Department of Oral- and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany; (M.G.); (B.B.-B.)
| | - Benedicta Beck-Broichsitter
- Department of Oral- and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany; (M.G.); (B.B.-B.)
| | - Peer W. Kämmerer
- Department of Oral- and Maxillofacial Surgery, University Medical Center Mainz, Augustusplatz 2, 55131 Mainz, Germany; (L.K.M.); (P.W.K.)
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