Background

Significant disruptions to cancer diagnostic pathways have been observed in adults during the COVID-19 pandemic, however, the extent to which this has affected childhood, teenage and young adult (CTYA) cancers is unknown. We aimed to investigate how the first wave of the pandemic affected CTYA cancer 1) incidence rates, 2) diagnostic and treatment time-intervals and 3) cancer-related intensive care (ICU) admissions in England.

Method

Central nervous system (CNS) tumours, lymphomas, leukaemias, sarcomas and renal tumours in CTYA were identified using QResearch, a nationally representative primary care database, linked to hospital admission, mortality and cancer registry data. Incident cancer diagnoses between 1^st February-15^th August 2020 were compared to the three preceding pre-pandemic years using an interrupted time-series Poisson regression-analysis. Diagnostic and treatment time-intervals and ICU admissions were compared through quantile and logistic regression, respectively.

Results

2607 CTYA cancers were diagnosed from 1^st January 2017-15^th August 2020, 380 during the pandemic. Overall, 17% (95%CI -38.0% to -6.0%) reduction in the incidence-rate-ratio of CTYA cancers was observed during the pandemic. Specific decreases were seen for CNS tumour [-38% (95%CI -52% to -21%)] and lymphoma [-28% (95%CI -45% to -5%)] diagnoses. Additionally, childhood cancers diagnosed during the pandemic were significantly more likely to have ICU admissions [adjusted odds ratio 2.2 (95%CI 1.33-3.47)]. Median time-to-diagnosis did not significantly differ across periods [+4.5 days (95%CI -20.5 to +29.5)], whilst median time-to-treatment was shorter during the pandemic [-0.7 days (95%CI -1.1 to -0.3)].

Conclusion

The COVID-19 pandemic has led to substantial reduction in childhood, teenage and young adult cancer detection during the first wave, with an increase in cancer-related ICU admissions, suggesting more severe baseline disease at diagnosis. Collectively, these findings demonstrate disruptions to cancer diagnostic pathways in this age group. Our findings have significant implications for the early diagnosis and management of CTYA cancers, which need to be addressed urgently in the recovery phase of the pandemic.

Impact statement

Our findings demonstrate disruptions to childhood, teenage and young adult cancer diagnostic pathways during the COVID-19 pandemic, which need to be addressed urgently in the recovery phase of the pandemic.