Since the first months of 2020, the European Cancer community has mobilised its resources to understand, quantify and address the impacts of the Covid-19 pandemic on all areas of cancer control. Numerous deeply alarming reports and data are continuously being received by the European Cancer Organisation, from all stakeholders in the community, including from the European Cancer Organisation’s healthcare professional organisations and patient groups, across all European countries. All make it very clear: data intelligence is key to understanding the impact of the Covid-19 pandemic on cancer patients and cancer services. It can help drive timely decisions in tackling the dramatic situation faced by cancer patients and professionals across Europe, and will empower the European cancer community to draw relevant lessons that can help mitigate the impact of the pandemic.
In order to gather, analyse and further amplify all these available resources, the European Cancer Organisation has commissioned Data Intelligence work from IQVIA as part of the Time To Act campaign. Its aim is to build a pan-European evidence base of the impact that Covid-19 is having on cancer patients, cancer professionals and cancer services across the continent. In the first phase of this project, work has been completed to:
As a result of this work, a series of headline statements have been generated across seven key areas highlighting the impact of Covid-19 on Cancer. These have been informed by consolidated qualitative and quantitative intelligence and reinforced by both published reports and direct testimonies of cancer professionals and patients.
At current rates, as of February 2021, an estimated 100,000 Cancer patients are added to the backlog every month.
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:
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.
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:
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.
This is already leading to later stage diagnoses and decreased overall survival.
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:
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.
This statement builds upon the analysis of data on:
Evidence from previous research helped inform the statement, including the following publications and reports:
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.
This is due to the backlog of screening tests, reduction and delays in referrals and restricted healthcare resources due to Covid-19
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:
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.
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:
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.
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:
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.
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:
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.
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:
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.
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:
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.
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:
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.
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:
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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