Impact of the Covid pandemic on timely cancer diagnosis across European healthcare settings: a scoping review.

Introduction: The COVID-19 pandemic presented unprecedented challenges to European healthcare systems. The study aimed to review the available evidence on the impact of the pandemic on the timely diagnosis of cancer across European countries. The primary objective was to examine changes in diagnostic pathways and stage at diagnosis during the pandemic, compared to the pre-pandemic period, across European countries, taking healthcare system characteristics and COVID-19 policies into account. Methods: We conducted a review of the impact of the pandemic on cancer diagnosis in Europe, analyzing primary studies from 2018 to 2023 using both quantitative and qualitative methods through searches in PubMed and Scopus databases. Study quality was assessed using the Mixed Methods Appraisal Tool. The main explanatory factors analyzed were grouped into two categories: Covid-policies (government responses, using the Oxford COVID-19 Government Response Tracker and its stringency index as key metrics) and healthcare characteristics (healthcare system models, expenditure and resources, including hospital beds and the ratio of medical doctors). Study design: Scoping review. Results: Overall, 127 papers were screened, 80 retrieved for full-text evaluation and 50 articles were included in the review. The studies encompassed a total of 509,753 patients from 17 European countries. The pandemic period was characterised by worse process and outcome measures for all examined cancers, except for lung cancer, compared to the pre-pandemic period. Group-ing countries based on government actions and policy responses (stringency index) did not show any differences in timely cancer diagnosis. Countries with lower healthcare expenditure (per capita expenditure <2,000 euros) or lower investments in prevention reported more cancer diagnostic delays during the pandemic. Countries with >20% of General Practitioners over the total number of physicians and with more hospital beds per population experienced fewer diagnostic delays during the pandemic. Conclusions: Overall, the review suggests that diagnostic pathways and cancer stage at diagnosis during the COVID-19 pandemic varied across Europe, with countries' healthcare expenditure, investments in prevention, the proportion of General Practitioners and the number of hospital beds per population possibly playing a role. This analysis can inform healthcare policies aimed at addressing post-pandemic challenges and formulating resilience plans for future emergencies.

Delays in cancer diagnosis: challenges and opportunities in Europe.

BACKGROUND AND AIM: Early cancer diagnosis is a public health priority, but large proportions of patients are diagnosed with advanced disease or as an emergency, even in countries with universal healthcare coverage. The study aimed at examining factors contributing to diagnostic delays and inequalities in cancer care, discussing challenges and opportunities for improving the diagnosis of cancer. METHODS: We performed a critical review of the literature examining factors contributing to delays and inequalities in cancer diagnosis, published between 2019-2023, in Europe with a specific focus on Italy. RESULTS: Disparities in screening, cancer diagnosis and treatment have been reported in many European countries, with poorer outcomes for some population sub-groups. For example, some Northern regions in Italy have six-times higher screening participation versus Southern regions. In 2019 36% of the Italian population aged 50-74 reported colorectal cancer screening, higher than the EU average (33%), but lower than in countries like Denmark (>60%). In Italy, the EU country with the largest percentage of people aged 65+, incident cancers are expected to rise by 19.6% over two decades. Older age is also associated with multimorbidity, with physical and mental health morbidities possibly affecting cancer diagnostic pathways. For example, colon cancer patients with pre-existing mental health conditions were 28% less likely to have a prompt colonoscopy when presenting with red-flag symptoms, according to recent UK research. Covid-19 has exacerbated pre-existing inequalities, with reductions in scheduled surgery and oncological treatments, especially affecting women, older and less educated individuals. CONCLUSIONS: For ensuring appropriate care, it is crucial to better understand how different factors, including physical and mental health morbidities, impact cancer diagnosis. The "NextGenerationEU" program and the "National Recovery and Resilience Plan" (PNNR in Italy) following the Covid-19 pandemic offer opportunities for reducing inequalities, improving cancer care and chronic disease management for ageing populations.