PDF(Pubmed)
Abstract：
BACKGROUND: In the Netherlands, the COVID-19 pandemic resulted in a temporary halt of population screening for cancer and limited hospital capacity for non-COVID care. We aimed to investigate the impact of the pandemic on the in-hospital diagnostic pathway of breast cancer (BC) and colorectal cancer (CRC).
METHODS: 71,159 BC and 48,900 CRC patients were selected from the Netherlands Cancer Registry. Patients, diagnosed between January 2020 and July 2021, were divided into six periods and compared to the average of patients diagnosed in the same periods in 2017-2019. Diagnostic procedures performed were analysed using logistic regression. Lead time of the diagnostic pathway was analysed using Cox regression. Analyses were stratified for cancer type and corrected for age, sex (only CRC), stage and region.
RESULTS: For BC, less mammograms were performed during the first recovery period in 2020. More PET-CTs were performed during the first peak, first recovery and third peak period. For CRC, less ultrasounds and more CT scans and MRIs were performed during the first peak. Lead time decreased the most during the first peak by 2 days (BC) and 8 days (CRC). Significantly fewer patients, mainly in lower stages, were diagnosed with BC (-47%) and CRC (-36%) during the first peak.
CONCLUSIONS: Significant impact of the COVID-19 pandemic was found on the diagnostic pathway, mainly during the first peak. In 2021, care returned to the same standards as before the pandemic. Long-term effects on patient outcomes are not known yet and will be the subject of future research.
METHODS: 71,159 BC and 48,900 CRC patients were selected from the Netherlands Cancer Registry. Patients, diagnosed between January 2020 and July 2021, were divided into six periods and compared to the average of patients diagnosed in the same periods in 2017-2019. Diagnostic procedures performed were analysed using logistic regression. Lead time of the diagnostic pathway was analysed using Cox regression. Analyses were stratified for cancer type and corrected for age, sex (only CRC), stage and region.
RESULTS: For BC, less mammograms were performed during the first recovery period in 2020. More PET-CTs were performed during the first peak, first recovery and third peak period. For CRC, less ultrasounds and more CT scans and MRIs were performed during the first peak. Lead time decreased the most during the first peak by 2 days (BC) and 8 days (CRC). Significantly fewer patients, mainly in lower stages, were diagnosed with BC (-47%) and CRC (-36%) during the first peak.
CONCLUSIONS: Significant impact of the COVID-19 pandemic was found on the diagnostic pathway, mainly during the first peak. In 2021, care returned to the same standards as before the pandemic. Long-term effects on patient outcomes are not known yet and will be the subject of future research.
摘要：
背景：在荷兰，COVID-19大流行导致癌症人群筛查暂时停止，非COVID护理的医院能力有限。我们旨在调查大流行对乳腺癌（BC）和结直肠癌（CRC）的院内诊断途径的影响。
方法：从荷兰癌症登记处选择了71,159例BC和48,900例CRC患者。患者,在2020年1月至2021年7月之间诊断，分为六个时期，并与2017-2019年同期诊断的患者平均值进行比较。使用逻辑回归分析进行的诊断程序。使用Cox回归分析诊断途径的前导时间。对癌症类型进行了分层分析，并校正了年龄，性别（仅CRC），舞台和区域。
结果：对于BC，在2020年的第一个恢复期，执行的乳房X光检查较少。在第一个峰期间进行了更多的PET-CT，第一次复苏和第三次高峰期。对于CRC，在第一个高峰期间进行的超声检查较少,CT扫描和MRI较多.在第一个高峰期间，提前时间减少了2天（BC）和8天（CRC）。患者明显减少，主要在较低的阶段，在第一个高峰期间诊断为BC（-47％）和CRC（-36％）。
结论：发现COVID-19大流行对诊断途径有重大影响，主要是在第一个高峰。2021年，护理恢复到与大流行前相同的标准。对患者预后的长期影响尚不清楚，将成为未来研究的主题。
方法：从荷兰癌症登记处选择了71,159例BC和48,900例CRC患者。患者,在2020年1月至2021年7月之间诊断，分为六个时期，并与2017-2019年同期诊断的患者平均值进行比较。使用逻辑回归分析进行的诊断程序。使用Cox回归分析诊断途径的前导时间。对癌症类型进行了分层分析，并校正了年龄，性别（仅CRC），舞台和区域。
结果：对于BC，在2020年的第一个恢复期，执行的乳房X光检查较少。在第一个峰期间进行了更多的PET-CT，第一次复苏和第三次高峰期。对于CRC，在第一个高峰期间进行的超声检查较少,CT扫描和MRI较多.在第一个高峰期间，提前时间减少了2天（BC）和8天（CRC）。患者明显减少，主要在较低的阶段，在第一个高峰期间诊断为BC（-47％）和CRC（-36％）。
结论：发现COVID-19大流行对诊断途径有重大影响，主要是在第一个高峰。2021年，护理恢复到与大流行前相同的标准。对患者预后的长期影响尚不清楚，将成为未来研究的主题。
