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Newly diagnosed cancer and the COVID-19 pandemic: tumour stage migration and higher early mortality
  1. Deniz Can Guven1,
  2. Taha Koray Sahin2,
  3. Hasan Cagri Yildirim1,
  4. Engin Cesmeci2,
  5. Fatima Gul Gulbahce Incesu2,
  6. Yagmur Tahillioglu2,
  7. Enes Ucgul2,
  8. Melek Seren Aksun2,
  9. Suleyman Cagin Gurbuz2,
  10. Oktay Halit Aktepe1,
  11. Zafer Arik1,
  12. Omer Dizdar1,
  13. Suayib Yalcin1,
  14. Sercan Aksoy1,
  15. Saadettin Kilickap1,3 and
  16. Neyran Kertmen1
  1. 1Cancer Institute, Department of Medical Oncology, Hacettepe University, Ankara, Turkey
  2. 2Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
  3. 3Department of Medical Oncology, Istinye University, Istanbul, Turkey
  1. Correspondence to Dr Deniz Can Guven, Cancer Institute, Department of Medical Oncology, Hacettepe University, Ankara, 06100, Turkey; denizcguven{at}


Background We compared the new outpatient clinic referrals during the first 10 months of the COVID-19 pandemic with the year before.

Methods We compared baseline characteristics of the 2208 new referrals in 2020 (n=922) and 2019 (n=1286) with Χ2 and Mann-Whitney U tests and calculated ORs with binary logistic regression. To evaluate the expected changes in the cancer survival secondary to stage migration, we used the 5-year survival data of Survival, Epidemiology and End Results (SEER) Program 2010–2016.

Results The percentage of patients with inoperable or metastatic disease was significantly increased during the pandemic (49.8% vs 39%, OR: 1.553, 95% CI: 1.309 to 1.843, p<0.001). We observed a significant decrease in the percentage of patients diagnosed via the screening methods (18.8% vs 28.7%, OR: 1.698, 95% CI: 1.240 to 2.325, p=0.001). The 90-day mortality after the cancer diagnosis was significantly higher during the pandemic (10.5% vs 6.6%, OR: 1.661, 95% CI: 1.225 to 2.252, p=0.001). Due to the increased advanced-stage disease rate at first referral, significant decreases in 5-year survival rates were expected for breast cancer (−8.9%), colorectal cancer (−11.1%), cervix cancer (−10.3%) and melanoma (−7%).

Conclusion We think that collaborative efforts are paramount to prevent the pandemic of late cancer diagnoses and ensure patient safety during the pandemic.

  • cancer
  • COVID-19

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  • Contributors DCG and NK have planned the work. DCG, TKS, HCY, EC, FGGI, YT, EU, MSA, SCG, OHA, ZA, OD, SY, SA, SK and NK participated in patient care and data collection. All authors, namely DCG, TKS, HCY, EC, FGGI, YT, EU, MSA, SCG, OHA, ZA, OD, SY, SA, SK and NK have made significant and substantive contributions to the reporting of the work. All authors have participated in the review of relevant literature, drafting of the manuscript, review and revisions of the final draft. DCG, TKS, HCY and NK have analysed the data and determined the main conclusions. DCG has prepared the first draft of the manuscript. All authors reviewed and participated in the preparation of the revised and final version of the manuscript. DCG and NK are responsible for the overall content as guarantors. All coauthors qualify the criteria for authorship according to Vancouver protocol.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.