Impact of the COVID-19 Outbreak-Delayed Referral of Colorectal and Lung Cancer in Primary Care: A National Retrospective Cohort Study

C.W. Helsper*, C.H. Van Gils, N.F. Van Erp, M.F.R.S. van den Berg, O. Rogouti, K.M. Van Asselt, O.R. Maarsingh, J. Muris, D. Brandenbarg, S. Siesling, N.J. De Wit, M.P. Grant, COVID and Cancer Consortium

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Simple Summary The COVID-19 pandemic impacted health care. We studied the impact of the COVID-19 outbreak on the referral and diagnosis of cancer patients, thereby aiming to help prevent the delay of cancer diagnosis in future pandemics. We found that during the COVID-19 outbreak, the time between presentation and referral in primary care for patients with colorectal and lung cancer was substantially increased. This was also seen for patients who presented with alarm symptoms. This shows that, in future pandemics, targeted GP support is needed to maintain effective cancer diagnosis. The Coronavirus disease 2019 (COVID-19) outbreak impacted health care. We investigated its impact on the time to referral and diagnosis for symptomatic cancer patients in The Netherlands. We performed a national retrospective cohort study utilizing primary care records linked to The Netherlands Cancer Registry. For patients with symptomatic colorectal, lung, breast, or melanoma cancer, we manually explored free and coded texts to determine the durations of the primary care (IPC) and secondary care (ISC) diagnostic intervals during the first COVID-19 wave and pre-COVID-19. We found that the median IPC duration increased for colorectal cancer from 5 days (Interquartile Range (IQR) 1-29 days) pre-COVID-19 to 44 days (IQR 6-230, p < 0.01) during the first COVID-19 wave, and for lung cancer, the duration increased from 15 days (IQR) 3-47) to 41 days (IQR 7-102, p < 0.01). For breast cancer and melanoma, the change in IPC duration was negligible. The median ISC duration only increased for breast cancer, from 3 (IQR 2-7) to 6 days (IQR 3-9, p < 0.01). For colorectal cancer, lung cancer, and melanoma, the median ISC durations were 17.5 (IQR (9-52), 18 (IQR 7-40), and 9 (IQR 3-44) days, respectively, similar to pre-COVID-19 results. In conclusion, for colorectal and lung cancer, the time to primary care referral was substantially prolonged during the first COVID-19 wave. In such crises, targeted primary care support is needed to maintain effective cancer diagnosis.
Original languageEnglish
Article number1462
Number of pages12
Issue number5
Publication statusPublished - 1 Mar 2023


  • cancer diagnosis
  • primary care
  • delay
  • TIME

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