The impact of the first COVID-19 wave on the diagnostic trajectory of breast cancer in the Netherlands

Abstract

Introduction Breast cancer is the most common form of cancer in women. From the start of the COVID-19 pandemic, healthcare was reorganized and diagnoses of breast cancer were decreased. The aim of this report is to assess the impact of the first COVID-19 wave on the diagnostic trajectory of symptomatic breast cancer patients in primary care in the Netherlands. Method A retrospective cohort study was performed using Electronic Health Records to identify symptomatic patients with breast cancer. Those patients were internally validated. The primary outcomes were the patient and the primary care interval. Furthermore, the stratified and long durations were assessed, and the data was compared to DICKENS-1. Results A total of 158 symptomatic breast cancer patients were identified. The IP was 18 days (IQR 4- 37) and the IPC was 1 day (IQR 1-2). Compared to DICKENS-1 the IPC was significantly longer (p-value 0.026). Less than four consults in the year before COVID-19 was associated with a shorter IP. A factor associated with a long duration of the IP was breast cancer related comorbidities. A non-physical first consults and no alarm symptoms were associated with a longer IPC and with a higher risk of having a long duration. Conclusion The COVID-19 pandemic had an impact on prolonging the IPC of patients with breast cancer, but not on the IP. Future research should be focused on defining reasons for this prolongation and developing support for GPs to diagnose the patients at risk for a long duration.