BASIC DATA OF THE RESEARCH PROJECT

• ARRS code: V3-2032
• TITLE: The impact of COVID-19 on the cancer management in Slovenia
• PROJECT LEADER: Tina Žagar, PhD
• DURATION: 1.10.2020 - 30.9.2022
• APPLICANT RESEARCH ORGANISATION: INSTITUTE OF ONCOLOGY LJUBLJANA
• PARTICIPATING RESEARCH ORGANISATIONS: Nacional institute of public health
• FINANCING: Slovenian Research Agency

BACKGROUND

Every year 15,000 Slovenians are newly diagnosed with cancer, while over 6,000 die from cancer. There are currently over 110,000 people alive in Slovenia who have already been diagnosed with cancer. The outcome of cancer treatment is generally considered to be better if the diagnosis is made at the earliest possible stage, if the appropriate therapy is started as soon as possible and if the treatment is comprehensive.

At the beginning of 2020, specific events took place in Slovenia as well as in other countries around the world, which followed the spread of the new corona virus SARS-CoV-2 and the declaration of a COVID-19 pandemic.

Many oncology experts point to possible problems in the availability and use of oncology services during and after restrictive measures introduced during the epidemic. Restrictions and preventive measures, which have certainly helped to limit the spread of the infection and ensured the healthcare system did not get overburdened, have also had negative consequences for oncology patients, which can be long-term or permanent. During the COVID-19 epidemic, Slovenia introduced a number of restrictions and changes in the organisation of the healthcare, as well as in society as a whole. Such as mobility limitations, changes to provision of primary health services with more telephone consultations and less face-to-face visits, suspension of non-urgent health services, including diagnostic procedures for non-specific symptoms, which are often the first sign of cancer, the cancer screening programmes and oncology genetic counselling were also temporarily suspended. Following all the restrictions and changes, there were also changes in the usual health care seeking behaviour of people, which could all lead to the delay in diagnosis of cancer and initiation of treatment. There were also some protective measures introduced in the oncology health care, which may have affected the course of specific oncology treatment.

As already observed in a smaller preliminary study by Slovenian Cancer Registry, despite the fact that the oncology health care was an exception to the above-mentioned general restrictions in health care provision during the epidemic, there was a significant drop in the number of referrals for first and control oncological examinations and genetic counselling examinations. There was also a decrease in the number of new cancer cases and a decrease in the number of performed diagnostic procedures at the Institute of Oncology Ljubljana.

Cancer is one of the most important public health issues of our population; the burden of this disease far exceeds the current burden of COVID-19. Uninterrupted treatment of oncological patients is therefore one of the key objectives for society, even in times of infectious diseases epidemics or other crises. With the proposed project, we want to contribute to the improvement of systemic cancer management also in the time of (any) future emergency.

AIMS AND OBJECTIVES

In the proposed project, we want to investigate the impact of the COVID-19 epidemic on the burden of cancer and the functioning of the oncology health care system in Slovenia by using the existing health care databases (and their linkage). Our goals are to:

• Assess possible delays in referrals, diagnostics and specialist treatments of Slovenian oncology patients during the COVID-19 epidemic.

• To study the course and outcomes of treatment of Slovenian oncology patients with COVID-19.

• To determine the possible deterioration of prognostic factors of the disease in oncology patients (not) diagnosed during the epidemic due to adjustments in the functioning of the health care system.

SCOPE

The assessment of the effects of the epidemic on cancer burden is possible by using existing national Cancer Registry and other available health care data sources. Thus the project will be carried out by two leading institution in the field of public health, that is Institute of Oncology Ljubljana – mainly Epidemiology and Cancer Registry unit and Oncology Genetic Counselling unit, and National Institute of Public Health – Center for Infectious Diseases.

In the project, we want to study referrals to oncology treatment, the number of newly reported cancer cases and the use of diagnostic procedures in oncology patients during the changed functioning of the health care system and the changed population behaviour due to measures introduced for limiting the spread of the COVID-19. Special emphasis will be placed on studying the impact of the COVID-19 epidemic on referrals for oncology genetic counselling and testing at the national level and assessing possible delays in clinical treatments of these patients and their relatives.

Further, we want to determine the course of treatment in oncology patients who also had COVID-19. This could be possible by linking the cancer data from the Institute of Oncology Ljubljana and data on COVID-19 patients managed by the National Institute of Public Health. In those patients, we will analyse the course of oncology treatment, possible deviations, as well as other outcomes of cancer.

We also want to analyse the impact of the suspension of the national screening program for early detection of breast cancer DORA. Due to the suspension and due to the adjustment of screening schedules after the re-establishment of the screening program, there was a delay in the recommended interval for performing screening mammography. This could lead to the detection of larger or more extensive breast cancers in women after re-establishment of the screening program.

RESULTS AND THEIR EXPECTED IMPACT

The project results will provide us with the evidence of the impact of the COVID epidemic on the burden of cancer in Slovenia. Using different data sources, we will try to cover different aspects in the course of cancer disease from screening and prevention, diagnostics, treatment and outcomes in oncology patients. If data linkage will be possible, we will also explore the impact of COVID-19 in cancer patients on their underlying disease and treatment.

The findings will contribute to the understanding of the short- and long-term consequences that the COVID-19 epidemic had on the burden of cancer in Slovenia. Such evidence may serve as a basis for action in the event of a subsequent wave of the COVID-19 epidemic or other similar circumstances of temporary impaired / rendered access to primary and / or specialist health care services. The findings will serve as an important input to the National Cancer Control Program, both as part of the ongoing monitoring of the cancer burden in Slovenia, and more importantly as a basis for preparation of measures to mitigate or prevent possible deterioration of cancer burden in similar future conditions by providing a robust oncology health care system with high level of quality and comprehensiveness of cancer care.