Clinicians across Europe saw 1.5 million fewer Cancer patients in the first year of the pandemic

At current rates, as of February 2021, an estimated 100,000 Cancer patients are added to the backlog every month.

Supporting Evidence

This statement builds upon the analysis of data on cancer caseload dips that have occurred throughout 2020 compared to pre-pandemic levels, both at European and national level. Evidence from previous research helped inform the statement, including the following publications and reports:

• Bertaglia, Valentina, “Italian Survey on the clinical management of non-small cell lung cancer patients during the COVID-19 pandemic: a lesson for the second wave”, Critical Reviews in Oncology/Hematology, 2021, vol 157, 103189
• NHS England. Waiting times for suspected and diagnosed cancer patients for April 2020. 11 June 2020
• Lai, Alvina G., et al. "Estimated impact of the COVID-19 pandemic on cancer services and excess 1-year mortality in people with cancer and multimorbidity: near real-time data on cancer care, cancer deaths and a population-based cohort study." BMJ open 10.11 (2020): e043828
• IQVIA, The Impact of COVID-19 on Cancer Treatment - EU4 & UK Report

These data have, in addition, been consolidated and validated through targeted questions to high-level expert cancer professionals and patient advocates from the European Cancer community on cancer patient loads observed during the pandemic, as part of the study’s primary intelligence interviews.

The relative drop in cancer in cancer patient load has subsequently been applied to latest yearly cancer incidence data retrieved from the World Health Organisation’s Global Cancer Observatory database, in order to obtain a pan-European estimate of the number of ‘missing’ cancer patients, that have not been seen by cancer professionals in the first year of the pandemic.

Urgent Cancer referrals were cut by up to half due to the pandemic

Supporting Evidence

This statement builds upon the analysis of data on urgent cancer referrals obtained throughout 2020 across several European countries compared to pre-pandemic levels. Evidence from previous research helped inform the statement, including the following publications and reports:

• Cancer Research UK. Over 2 million people in backlog for cancer care. 1 June 2020
• Lai, Alvina G., et al. "Estimated impact of the COVID-19 pandemic on cancer services and excess 1-year mortality in people with cancer and multimorbidity: near real-time data on cancer care, cancer deaths and a population-based cohort study." BMJ open 10.11 (2020): e043828
• NHS England. Waiting times for suspected and diagnosed cancer patients for April 2020. 11 June 2020
• Cancer the forgotten ‘C’ of the Covid crisis. July/August 2020
• Irish Cancer Society. Irish Cancer Society concerned about decline in cancer diagnosis during COVID-19. 01 May 2020
• Radio Sweden. Worries grow over undetected cancer cases as pandemic pauses screening. 06 May 2020

These data have, in addition, been consolidated and validated through targeted questions to high-level expert cancer professionals and patient advocates from the European Cancer community on the numbers of cancer referrals observed during the pandemic, as part of the study’s primary intelligence interviews.

An estimated 100 million Cancer screening tests were not performed in Europe as a result of the pandemic

This is already leading to later stage diagnoses and decreased overall survival.

Supporting Evidence

This statement builds upon the analysis of data on the breast, cervical and colorectal cancer screening backlog throughout 2020, compared to pre-pandemic levels, at national and international level. Evidence from previous research helped inform the statement, including the following publications and reports:

• Connexion France. 30,000 cancer cases undetected in France due to Covid-19. 26 October 2020
• Meyer, Antoine, et al. "Colonoscopy in France during the COVID-19 pandemic." International Journal of Colorectal Disease (2021): 1-3
• The Irish Times. ‘Massive catch-up’ needed for main cancer screening programmes. 1 September 2020
• Italian National Oncology Association (2020), “Tumori: “Un milone e 400 mila screening in meno nei primi mesi del 2020. Rischio diagnosi piu avanzate, servono risorse per la telemedicina””, ESMO conference
• Lantinga, Marten A., et al. "Impact of the COVID-19 pandemic on gastrointestinal endoscopy in the Netherlands: analysis of a prospective endoscopy database." Endoscopy 53.2 (2021): 166
• Ho, Kai Man Alexander, et al. "Predicting endoscopic activity recovery in England after COVID-19: a national analysis." The Lancet Gastroenterology & Hepatology 6.5 (2021): 381-390
• Sravanthi, et al. "Global impact of the COVID-19 pandemic on endoscopy: an international survey of 252 centers from 55 countries." Gastroenterology 159.4 (2020): 1579-1581

These data have, in addition, been consolidated and validated through targeted questions to high-level expert cancer professionals and patient advocates from the European Cancer community, on matters such as declines in monthly number of patients being screened observed during the pandemic, national pauses in cancer screening programmes, and initiatives already being employed to clear the cancer screening backlog, as part of the study’s primary intelligence interviews.

On the basis of this intelligence, a median relative cancer screening backlog for Europe was estimated and applied to the expected annual number of cancer screening tests in the EU and the UK, retrieved from the latest report on the implementation of cancer screening programmes in the EU, produced in 2017 by the International Agency for Research on Cancer (IARC) for the European Commission, in order to obtain a pan-European estimate of the number of ‘missed’ cancer screening tests as a result of the Covid-19 pandemic.

European oncology experts agree it could take at least 12 months to clear the backlog of people waiting to be screened for Cancer

Supporting Evidence

This statement builds upon the analysis of data on:

• the number of cancer screening tests performed during the pandemic;
• the potential of increased cancer screening capacity to clear the backlog accumulated during the pandemic; and,
• the possible impact of further interruptions of cancer screening programmes, obtained throughout 2020 across several European countries.

Evidence from previous research helped inform the statement, including the following publications and reports:

• Meyer, Antoine, et al. "Colonoscopy in France during the COVID-19 pandemic." International Journal of Colorectal Disease (2021): 1-3
• Ho, Kai Man Alexander, et al. "Predicting endoscopic activity recovery in England after COVID-19: a national analysis." The Lancet Gastroenterology & Hepatology 6.5 (2021): 381-390

These data have, in addition, been consolidated and validated through targeted questions to high-level expert cancer professionals and patient advocates from the European Cancer community on the capacity and means to address the cancer screening backlog, as part of the study’s primary intelligence interviews.

One million Cancer patients could be undiagnosed

This is due to the backlog of screening tests, reduction and delays in referrals and restricted healthcare resources due to Covid-19

Supporting Evidence

This statement builds upon the analysis of data on the breast, cervical and colorectal cancer screening backlog that occurred throughout 2020 compared to pre-pandemic at national and international level and on the impact of the pandemic on urgent referrals. Evidence from previous research helped inform the statement, including the following publications and reports:

• Connexion France. 30,000 cancer cases undetected in France due to Covid-19. 26 October 2020
• Meyer, Antoine, et al. "Colonoscopy in France during the COVID-19 pandemic." International Journal of Colorectal Disease (2021): 1-3
• The Irish Times. ‘Massive catch-up’ needed for main cancer screening programmes. 1 September 2020
• Italian National Oncology Association (2020), “Tumori: “Un milone e 400 mila screening in meno nei primi mesi del 2020. Rischio diagnosi piu avanzate, servono risorse per la telemedicina””, ESMO conference
• Lantinga, Marten A., et al. "Impact of the COVID-19 pandemic on gastrointestinal endoscopy in the Netherlands: analysis of a prospective endoscopy database." Endoscopy 53.2 (2021): 166
• Ho, Kai Man Alexander, et al. "Predicting endoscopic activity recovery in England after COVID-19: a national analysis." The Lancet Gastroenterology & Hepatology 6.5 (2021): 381-390
• Sravanthi, et al. "Global impact of the COVID-19 pandemic on endoscopy: an international survey of 252 centers from 55 countries." Gastroenterology 159.4 (2020): 1579-1581

These data have, in addition, been consolidated and validated through targeted questions to high-level expert cancer professionals and patient advocates from the European Cancer community, on declines in monthly number of people being screened during the pandemic, decreases in urgent referrals, national pauses in cancer screening programmes, and initiatives already being taken to clear the cancer screening backlog, as part of the study’s primary intelligence interviews.

On the basis of this intelligence, a median relative cancer screening backlog for Europe was estimated and applied to the latest yearly cancer incidence data for breast, cervical and colorectal cancer retrieved from the World Health Organisation’s Global Cancer Observatory database, and the proportion these cancers represent of all diagnosed cancers in a year was taken into account, in order to partially inform a pan-European estimate of the number of ‘missed’ cancer diagnoses during the Covid-19 pandemic.

Due to disruption of early Cancer detection programs (e.g., breast, cervical, colorectal) patients are already being diagnosed with more advanced Cancers

Supporting Evidence

This statement builds upon the analysis of data on declines in diagnosed cancer cases for the most common cancer types and excess cancer deaths expected as a result of delays in cancer diagnosis, obtained throughout 2020 across several European countries.  Evidence from previous research helped inform the statement, including the following publications and reports:

• Blay, J. Y., et al. "Delayed care for patients with newly diagnosed cancer due to COVID-19 and estimated impact on cancer mortality in France." ESMO Open (2021): 100134.
• Kampf, Günter, and Martin Kulldorff. "Calling for benefit–risk evaluations of COVID-19 control measures." The Lancet 397.10274 (2021): 576-577
• De Vincentiis, Ludovica, et al. "Cancer diagnostic rates during the 2020 ‘lockdown’, due to COVID-19 pandemic, compared with the 2018–2019: an audit study from cellular pathology." Journal of clinical pathology 74.3 (2021): 187-189
• Vanni, Gianluca, et al. "Lockdown of Breast Cancer Screening for COVID-19: Possible Scenario." in vivo 34.5 (2020): 3047-3053
• Maringe, Camille, et al. "The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population-based, modelling study." The lancet oncology 21.8 (2020): 1023-1034

These data have, in addition, been consolidated and validated through targeted questions to high-level expert cancer professionals and patient advocates from the European Cancer community, on (i) declines in numbers of patients being diagnosed compared to pre-pandemic levels and (ii) shifts in cancer stage at the time of diagnosis observed during the pandemic, as part of the study’s primary intelligence interviews. Importantly, these interviews showed that the impact on cancer diagnosis has been the largest for cancer types with fewer symptoms and/or relying on screening for their early detection.

Treatment delays due to Covid-19 in 2020 affected 1 in 2 Cancer patients in Europe and continue to affect 1 in 5

Supporting Evidence

This statement builds upon the analysis of data on disruptions, reductions and interruptions in the provision of cancer surgery and chemotherapy, as well as declines in patient volumes in corresponding services obtained throughout 2020, when compared to pre-pandemic levels at national and European level. Evidence from previous research helped inform the statement, including the following publications and reports:

• 'Candesic. Cancer the forgotten ‘C’ of the Covid crisis. July/August 2020
• Covid-19 Pandemic Halts Cancer Care And Damages Oncologists’ Wellbeing. 14 Sep 2020.
• Onesti, Concetta Elisa, et al. "Expected Medium-and Long-Term Impact of the COVID-19 Outbreak in Oncology." JCO Global Oncology 5.1 (2021): 162-172
• Slotman, Berend J., et al. "Effect of COVID-19 pandemic on practice in European radiation oncology centers." Radiotherapy and Oncology 150 (2020): 40-42

These data have, in addition, been consolidated and validated through targeted questions to high-level expert cancer professionals and patient advocates from the European Cancer community on the dynamics of the numbers of cancer patients being provided with cancer surgery and chemotherapy throughout the Covid-19 pandemic, as part of the study’s primary intelligence interviews.

An estimated 1 in 10 European Cancer patients are not receiving the radiotherapy they need due to concerns around Covid-19

Supporting Evidence

This statement builds upon the analysis of data on disruptions, reductions and interruptions in the provision of radiation therapy to cancer patients, as well as declines in patient volumes in corresponding services obtained throughout 2020, compared to pre-pandemic levels, at national and European level. Evidence from previous research helped inform the statement, including the following publications and reports:

• 'Candesic. Cancer the forgotten ‘C’ of the Covid crisis. July/August 2020
• COVID-19 PANDEMIC HALTS CANCER CARE AND DAMAGES ONCOLOGISTS’ WELLBEING. 14 Sep 2020.
• Onesti, Concetta Elisa, et al. "Expected Medium-and Long-Term Impact of the COVID-19 Outbreak in Oncology." JCO Global Oncology 5.1 (2021): 162-172
• Slotman, Berend J., et al. "Effect of COVID-19 pandemic on practice in European radiation oncology centers." Radiotherapy and Oncology 150 (2020): 40-42
• IQVIA, The Impact of COVID-19 on Cancer Treatment - EU4 & UK ReportThe Impact of COVID-19 on Cancer Treatment - EU4 & UK Report

These data have, in addition, been consolidated and validated through targeted questions to high-level expert cancer professionals and patient advocates from the European Cancer community, on the dynamics of the numbers of cancer patients being provided with radiation therapy throughout the Covid-19 pandemic when compared with pre-pandemic levels, as part of the study’s primary intelligence interviews.

A surgical delay of 12 weeks for all breast Cancer patients for a year could lead to 12,000 excess deaths across Europe

Supporting Evidence

This statement builds upon a published systematic review and meta-analysis of the impact of delays in the provision of cancer surgery on cancer patients’ survival in the United Kingdom (Hanna, Timothy P., et al. "Mortality due to cancer treatment delay: systematic review and meta-analysis." BMJ 371 (2020)).

It is consolidated by additional data on the impact of cancer treatment delays on cancer progression and cancer deaths, obtained across several European countries. Evidence from previous research helped inform the statement, including the following publications and reports:

• Blay, J. Y., et al. "Delayed care for patients with newly diagnosed cancer due to COVID-19 and estimated impact on cancer mortality in France." ESMO Open (2021): 100134.
• Vanni, Gianluca, et al. "Lockdown of Breast Cancer Screening for COVID-19: Possible Scenario." in vivo 34.5 (2020): 3047-3053.

The obtained relative amount of excess cancer deaths predicted has subsequently been applied to latest Eurostat data on the population and mortality of European Union countries and the United Kingdom in order to obtain a pan-European estimate of the potential excess cancer deaths entailed by a 12-week surgical delay for European breast cancer patients.

The pandemic has taken its toll on healthcare workers with 4 in 10 feeling burnout and 3 in 10 reportedly showing signs of clinical depression

Supporting Evidence

This statement builds upon the analysis of data on the impact of the Covid-19 pandemic on the emotional well-being and mental health of the cancer workforce, obtained throughout 2020 across several European countries and at international level. Evidence from previous research helped inform the statement, including the following publications and reports:

• Giusti, Emanuele Maria, et al. "The psychological impact of the COVID-19 outbreak on health professionals: a cross-sectional study." Frontiers in Psychology 11 (2020)
• Simione, Luca, and Camilla Gnagnarella. "Differences between health workers and general population in risk perception, behaviors, and psychological distress related to COVID-19 spread in Italy." Frontiers in psychology 11 (2020): 2166
• British Medical Association. The mental health and wellbeing of the medical workforce – now and beyond COVID-19. May 2020
• Health and Safety Executive. Work-related stress, anxiety or depression statistics in Great Britain, 2020
• Chatzittofis, Andreas, et al. "Impact of the COVID-19 Pandemic on the Mental Health of Healthcare Workers." International Journal of Environmental Research and Public Health 18.4 (2021): 1435
• Banerjee, S., et al. "LBA70_PR The impact of COVID-19 on oncology professionals: Initial results of the ESMO resilience task force survey collaboration." Annals of Oncology 31 (2020): S1200
• De Hert, Stefan. "Burnout in Healthcare Workers: Prevalence, Impact and Preventative Strategies." Local and Regional Anesthesia 13 (2020): 171

These data have, in addition, been consolidated and validated through multiple testimonies received from high-level expert cancer professionals and patient advocates from the European Cancer community, of the dramatic impact of the Covid-19 pandemic on cancer teams and cancer workers, as part of the study’s primary intelligence interviews.

Due to fears of contracting Covid-19, patients are less likely to attend follow-up visits for early-stage Cancer treatment

Supporting Evidence

This statement builds upon the analysis of data on cancer patients’ attitudes and concerns about engaging with healthcare systems during the Covid-19 pandemic, obtained throughout 2020 at national and international level. Evidence from previous research helped inform the statement, including the following publications and reports:

• Hennessy, Maeve A., et al. "Chemotherapy in the Covid-19 era: the patient’s perception." Irish Journal of Medical Science (1971-) (2021): 1-6
• The International Brain Tumour Alliance. Brain tumours and COVID-19: the patient and caregiver experience
• IQVIA Institute. Cancer Won’t Wait. March 2021
• Vrdoljak, Eduard, Richard Sullivan, and Mark Lawler. "Cancer and coronavirus disease 2019; how do we manage cancer optimally through a public health crisis?" European Journal of Cancer 132 (2020): 98-99

These data have, in addition, been consolidated and validated through multiple testimonies received from high-level expert cancer professionals and patient advocates from the European Cancer community of the anxiety and challenges faced by cancer patients during the Covid-19 pandemic, as part of the study’s primary intelligence interviews.

Self-examination, mobile screening units and prioritising those most at risk are some effective initiatives underway to address the breast Cancer backlog in Europe

Supporting Evidence

This statement builds upon established knowledge on initiatives taken in cancer services in order to mitigate the impact of the Covid-19 pandemic, gathered throughout 2020 at national and international level. Evidence from previous research helped inform the statement, including the following publications and reports:

• IQVIA Institute. Cancer Won’t Wait. March 2021
• De Benito E. La covid no interfiere en el cancer de mama, pero retrasa su diagnostico [Covid does not interfere with breast cancer, but it delays its diagnosis]. El Pais [Internet] (Madrid Ed.). 2020 Oct 19 [cited 2021 Jan 4]; Sociedad

Additional insight was also gained from direct testimonies received from high-level expert cancer professionals and patient advocates from the European Cancer community, of adaptations and different procedures being put in place in cancer control across Europe, as part of the study’s primary intelligence interviews.

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