Delay in Cancer Diagnosis During the Era of the Coronavirus Disease 2019 Pandemic: Learning lessons

Cancer is one of the leading causes of mortality worldwide and was responsible for an estimated 9.6 million deaths in 2018, with the majority (70%) occurring in low- and middle-income countries (LMICs).1 Furthermore, cancer survival tends to be poor in LMICs, most likely due to delays in cancer diagnosis, limited access to resources and a lack of national cancer screening programmes.2 As such, the number of cancer-related deaths can be reduced if patients are diagnosed and treated early.1 Delay in cancer diagnosis can occur at any point along the diagnostic spectrum, from the first observation of symptoms to the start of treatment and are typically categorised within one of the three time intervals: patient, primary care and secondary care intervals [Figure 1].3 Open in a separate window Figure 1 Diagram showing key time points and diagnostic intervals between observation of the first symptom of cancer until the start of treatment. Reproduced from Coxon D, Campbell C, Walter FM, Scott SE, Neal RD, Vedsted P, et al. The Aarhus statement on cancer diagnostic research: Turning recommendations into new survey instruments.3 In March 2020, the World Health Organization (WHO) declared that the coronavirus disease 2019 (COVID-19) virus had become a global health problem; accordingly, most countries developed specific policy responses to decrease the number of infections and slow the transmission of the virus, including the implementation of national lockdowns and social distancing guidelines.4 The intention behind these measures was to ‘flatten the curve’ of the infection and to minimise the impact of the pandemic on national healthcare services and resources.5 However, a recent study conducted in the UK predicted that the disruption of routine health services and other aspects of the COVID-19 pandemic would lead to a substantial increase in the frequency of avoidable deaths by 7.9–9.6% among patients with breast, colorectal, oesophageal and lung cancers as a result of diagnostic delays, resulting in a total of 59,204–63,229 additional lives lost in a year.6 In response to the pandemic, routine or non-urgent appointments in primary care settings were cancelled in many countries, including LMICs, and cancer screening services were suspended so as to limit gatherings of multiple individuals and decrease the risk of exposing patients and staff to possible sources of infection.7 Moreover, hospital resources were diverted to accommodate patients with severe illness due