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Fewer Cancer Diagnoses During COVID-19 Outbreak in the Netherlands

Multifactorial reasons involving patients, general practitioners and the healthcare system
14 May 2020

On 30 April 2020 in The Lancet Oncology, a group of researchers from the Netherlands reported on a notable decrease in cancer diagnoses in the country since the start of the COVID-19 pandemic. Substantial decreases in cancer diagnosis were reported across all age groups, geographical regions and in almost all types of cancer, although a higher impact on skin cancers was observed

Sabine Siesling of the Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht and the Department of Health Technology and Services Research, Technical Medical Centre, University of Twente in Enschede, Netherlands and colleagues analyzed data from the Netherlands Cancer Registry from 24 February 2020 to 12 April 2020 based on initial case declaration through pathological cancer notifications in the Nationwide Network of Histopathology and Cytopathology.

They describe multifactorial reasons for their findings from the point of view of the patient, doctor and healthcare system. 

Citizens in the Netherlands have universal access to essential healthcare services, but the general practitioner is a gatekeeper to secondary care. Individuals with non-specific cancer symptoms may feel that they are wasting the general practitioner's time on non-COVID-19-related symptoms. Furthermore, they may assume that essential non-COVID-19-related healthcare services are limited. Last, but not least, they may feel anxious about becoming infected with COVID-19 while visiting healthcare facilities.

Most of the general practitioner consultations for non-acute issues were switched to telehealth. Therefore, a general practitioner might postpone initial examinations for symptoms that are not immediately associated with a potential cancer diagnosis, leading to delays in further diagnostic referrels.

In terms of the impact on healthcare facilities, many hospital-based resources have been allocated to dealing with the COVID-19 pandemic. Furthermore, national screening programmes for breast, colorectal and cervical cancer were temporarily halted as of 16 March 2020. The effect of this pause in cancer diagnosis might be more evident after an extended follow-up period.

This observation of fewer cancer diagnoses during the COVID-19 outbreak has been disseminated within the Dutch community by the Netherlands Comprehensive Cancer Organisation, which hosts the Netherlands Cancer Registry, to create awareness of this important issue. Individuals were encouraged to consult their general practitioner in case of continued symptoms. General practitioners were also encouraged to refer patients with suspected cancer to cancer specialistsand an appeal was made to restart national cancer screening programmes. Misconceptions were eliminated about a heightened risk of contracting COVID-19 in a healthcare setting because of inadequate policies for infection control and resource limitations to deliver essential cancer care.

The Netherlands Cancer Registry plans to complete the registration of current and new cases via retrospective review of medical records. More detailed data including COVID-19 positivity status, tumour types and details on anticancer treatments, along with furtherfollow-up, will lead to a better understanding of the  effects of the COVID-19 outbreak on cancer care in the Netherlands. 


Dinmohamed AG, Visser O, Verhoeven RH, et al. Fewer cancer diagnoses during the COVID-19 epidemic in the Netherlands. The Lancet Oncology; Published online 30 April 2020; DOI: https://doi.org/10.1016/S1470-2045(20)30265-5

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