Fewer head and neck cancer diagnoses and faster treatment initiation during COVID-19 in 2020: A nationwide population-based analysis

Abstract

Background: Inevitably, the emergence of COVID-19 has impacted non-COVID care. Because timely diagnosis and treatment are essential, especially for patients with head and neck cancer (HNC) with fast-growing tumours in a functionally and aesthetically important area, we wished to quantify the impact of the COVID-19 pandemic on HNC care in the Netherlands.

Material and methods: This population-based study covered all, in total 8468, newly diagnosed primary HNC cases in the Netherlands in 2018, 2019 and 2020. We compared incidence, patient and tumour characteristics, primary treatment characteristics, and time-to-treatment in the first COVID-19 year 2020 with corresponding periods in 2018 and 2019 (i.e. pre-COVID).

Results: The incidence of HNC was nearly 25% less during the first wave (n = 433) than in 2019 (n = 595) and 2018 (n = 598). In April and May 2020, the incidence of oral cavity and laryngeal carcinomas was significantly lower than in pre-COVID years. There were no shifts in tumour stage or alterations in initial treatment modalities. Regardless of the first treatment modality and specific period, the median number of days between first visit to a HNC centre and start of treatment was significantly shorter during the COVID-19 year (26-28 days) than pre-COVID (31-32 days, p < 0.001).

Conclusion: The incidence of HNC during the Netherlands' first COVID-19 wave was significantly lower than expected. The expected increase in incidence during the remainder of 2020 was not observed. Despite the overloaded healthcare system, the standard treatment for HNC patients could be delivered within a shorter time interval.

Keywords: COVID-19; Cancer incidence; Delay; Head and neck cancer; Time-to-treatment.

Fig. 1

A: Incidence (crude rate) for head and neck cancer in the Netherlands during COVID-19 (2020, orange) vs. pre-COVID (2018 and 2019, dark and light blue)^a. B: Percentual difference of monthly incidence in 2020 (orange) and 2018/2019 (blue) compared to expected monthly incidence (n = 239) based on the monthly average in 2018/2019^a. ^aThe green dotted line shows the trend of COVID-19 related hospital admissions, marking the periods in which the healthcare system was overloaded, corresponding with the two following COVID-19 waves and accompanying lockdown measures. The grey background blocks indicate the Netherlands’ first and second COVID-19 wave and the accompanying lockdown measures (15 March – 1 June 2020, 14 October – 31 December 2020, respectively). The asterisks indicate a significant difference for 2018 vs. 2020 (COVID, dark blue asterisk) and for 2019 vs. 2020 (COVID, light blue asterisk).

Fig. 2

Incidence (crude rate per 1,000,000) for oral cavity (A), oropharyngeal (B), hypopharyngeal (C) and laryngeal (D) carcinomas. The grey background blocks indicate the Netherlands’ first and second COVID-19 wave and the accompanying lockdown measures (15 March – 1 June 2020, 14 October – 31 December 2020, respectively). The asterisks indicate a significant difference for 2018 vs. 2020 (COVID, dark blue asterisk) and for 2019 vs. 2020 (COVID, light blue asterisk).

Fig. 3

Violin plot showing the Care Pathway Interval (CPI) and Time-to-Treatment Interval (TTI^♯) during the first COVID-19 wave in 2020 (A) and during the recovery period in 2020 (1 June – 31 December, B) versus the same period in the two preceding years (2018 and 2019, pre-COVID). ^♯For TTI, patients with an interval of 0 days were excluded (COVID first peak n = 26 (7.1%) and n = 25 (5.7%) in recovery vs. n = 77 (7.6%) and n = 77 (6.4%) pre-COVID). The asterisk (*) indicates a significant difference between the COVID period (2020) and the corresponding periods in 2018 and 2019; p-value < 0.001. The size of the violin plot represents the number of individual data points, allowing more detailed interpretation of the distribution. The broken black line displays the median values, and the dotted lines display the 25th and 75th quartiles.