The Impact of the COVID-19 Pandemic on Bladder Cancer Care in the Netherlands

Abstract

Background: The COVID-19 pandemic has disrupted regular health care with potential consequences for non-COVID diseases like cancer. To ensure continuity of oncological care, guidelines were temporarily adapted.

Objective: To evaluate the impact of the COVID-19 outbreak on bladder cancer care in the Netherlands.

Methods: The number of bladder cancer (BC) diagnoses per month during 2020-2021 was compared to 2018-2019 based on preliminary data from the Netherlands Cancer Registry (NCR). Additionally, detailed data were retrieved from the NCR for the cohort diagnosed between March 1^st-May 31^st 2020 (first COVID wave) and 2018-2019 (reference cohort). BC diagnoses, changes in age and stage at diagnosis, and time to first-line treatment were compared between both periods. Changes in treatment were evaluated using logistic regression.

Results: During the first COVID wave (week 9-22), the number of BC diagnoses decreased by 14%, corresponding with approximately 300 diagnoses, but increased again in the second half of 2020. The decline was most pronounced from week 13 onwards in patients≥70 years and patients with non-muscle invasive BC. Patients with muscle-invasive disease were less likely to undergo a radical cystectomy (RC) in week 17-22 (OR = 0.62, 95% CI = 0.40-0.97). Shortly after the start of the outbreak, use of neoadjuvant chemotherapy decreased from 34% to 25% but this (non-significant) effect disappeared at the end of April. During the first wave, 5% more RCs were performed compared to previous years. Time from diagnosis to RC became 6 days shorter. Overall, a 7% reduction in RCs was observed in 2020.

Conclusions: The number of BC diagnoses decreased steeply by 14% during the first COVID wave but increased again to pre-COVID levels by the end of 2020 (i.e. 600 diagnoses/month). Treatment-related changes remained limited and followed the adapted guidelines. Surgical volume was not compromised during the first wave. Altogether, the impact of the first COVID-19 outbreak on bladder cancer care in the Netherlands appears to be less pronounced than was reported for other solid tumors, both in the Netherlands and abroad. However, its impact on bladder cancer stage shift and long-term outcomes, as well as later pandemic waves remain so far unexamined.

Keywords: Bladder cancer; COVID-19; disease stage; healthcare; impact; incidence; treatment.

Fig. 1

Bladder cancer diagnoses per month in the Netherlands in 2020 and 2021 versus the reference period 2018/2019.

Fig. 2

Three-week moving average of new bladder cancer diagnoses per week in the Netherlands in 2020 versus the reference period 2018/2019 (a) and relative to the reference period 2018/2019 (b), adjusted for the number of working days per week. GP: general practitioner. *a correction for working days was applied since this week does not contain 5 working days due to national holidays.

Fig. 3

Incidence of bladder cancer per 100,000 inhabitants per period of diagnosis, stratified by age at diagnosis. *In 2020, the incidence is significantly lower compared to the average incidence in 2018/2019 (p < 0.05).

Fig. 4

Incidence of bladder cancer per 100,000 inhabitants per period of diagnosis, stratified by disease stage. LR: low-risk; HR: high-risk; NMIBC: non-muscle invasive bladder cancer; MIBC: muscle-invasive bladder cancer; mBC: metastasized bladder cancer. *In 2020, the incidence is significantly lower compared to the average incidence in 2018/2019 (p < 0.05).

Fig. 5

Average time and standard deviation to upfront radical cystectomy (a), neo-adjuvant chemotherapy followed by radical cystectomy (b) and systemic chemotherapy (c) in days of patients with bladder cancer per period of treatment in 2020, compared to the reference period 2018/2019.

Fig. 6

Three-week moving average of radical cystectomies (for bladder cancer only) performed in the Netherlands** in 2020 relative to the reference period 2018/2019, corrected for the number of working days per week. *The number of cystectomies (for bladder cancer only) from week 38 on is partly based on provisional data. **One hospital was excluded from analysis due to a delay in registration leading to incomplete data.