The impact of the COVID-19 pandemic on cancer diagnosis and service access in New Zealand-a country pursuing COVID-19 elimination

Jason K Gurney; Elinor Millar; Alex Dunn; Ruth Pirie; Michelle Mako; John Manderson; Claire Hardie; Chris G C A Jackson; Richard North; Myra Ruka; Nina Scott; Diana Sarfati

doi:10.1016/j.lanwpc.2021.100127

The impact of the COVID-19 pandemic on cancer diagnosis and service access in New Zealand-a country pursuing COVID-19 elimination

Lancet Reg Health West Pac. 2021 May:10:100127. doi: 10.1016/j.lanwpc.2021.100127. Epub 2021 Mar 22.

Authors

Jason K Gurney^{1

2}, Elinor Millar¹, Alex Dunn¹, Ruth Pirie¹, Michelle Mako¹, John Manderson¹, Claire Hardie³, Chris G C A Jackson⁴, Richard North⁵, Myra Ruka⁶, Nina Scott⁶, Diana Sarfati¹

Affiliations

¹ Te Aho o Te Kahu - Cancer Control Agency, Molesworth St, Wellington, New Zealand.
² Department of Public Health, University of Otago, Mein St, Wellington, New Zealand.
³ Midcentral District Health Board, Ruahine Street, Palmerston North, New Zealand.
⁴ Department of Medicine, University of Otago, Great King St, Dunedin, New Zealand.
⁵ Bay of Plenty District Health Board, Cameron Rd, Tauranga, New Zealand.
⁶ Waikato District Health Board, Pembroke Street, Hamilton, New Zealand.

Abstract

Background: The COVID-19 pandemic has disrupted cancer services globally. New Zealand has pursued an elimination strategy to COVID-19, reducing (but not eliminating) this disruption. Early in the pandemic, our national Cancer Control Agency (Te Aho o Te Kahu) began monitoring and reporting on service access to inform national and regional decision-making. In this manuscript we use high-quality, national-level data to describe changes in cancer registrations, diagnosis and treatment over the course of New Zealand's response to COVID-19.

Methods: Data were sourced (2018-2020) from national collections, including cancer registrations, inpatient hospitalisations and outpatient events. Cancer registrations, diagnostic testing (gastrointestinal endoscopy), surgery (colorectal, lung and prostate surgeries), medical oncology access (first specialist appointments [FSAs] and intravenous chemotherapy attendances) and radiation oncology access (FSAs and megavoltage attendances) were extracted. Descriptive analyses of count data were performed, stratified by ethnicity (Indigenous Māori, Pacific Island, non-Māori/non-Pacific).

Findings: Compared to 2018-2019, there was a 40% decline in cancer registrations during New Zealand's national shutdown in March-April 2020, increasing back to pre-shutdown levels over subsequent months. While there was a sharp decline in endoscopies, pre-shutdown volumes were achieved again by August. The impact on cancer surgery and medical oncology has been minimal, but there has been an 8% year-to-date decrease in radiation therapy attendances. With the exception of lung cancer, there is no evidence that existing inequities in service access between ethnic groups have been exacerbated by COVID-19.

Interpretation: The impact of COVID-19 on cancer care in New Zealand has been largely mitigated. The New Zealand experience may provide other agencies or organisations with a sense of the impact of the COVID-19 pandemic on cancer services within a country that has actively pursued elimination of COVID-19.

Funding: Data were provided by New Zealand's Ministry of Health, and analyses completed by Te Aho o Te Kahu staff.

Keywords: COVID; COVID-19; Cancer; Cancer registration; Cancer services; Cancer treatment; Coronavirus.