Clinical Report: Impact of COVID-19 Pandemic on Renal Cancer Management in the Netherlands

Overview

The COVID-19 pandemic led to a significant initial decline in new renal cell carcinoma (RCC) diagnoses, especially for early-stage tumors and elderly patients, with a 10% overall reduction in 2020 compared to pre-pandemic years. Treatment patterns shifted modestly, with increased non-active management and decreased radical nephrectomies for T1a RCC during certain pandemic periods, while 2021 saw a return to baseline diagnosis rates.

Background

The COVID-19 pandemic caused widespread healthcare disruptions globally, including in the Netherlands where the first case was identified in February 2020. To prevent hospital overload, a national lockdown was implemented in March 2020, leading to postponement of non-urgent medical care and patient hesitancy to seek treatment. Adapted guidelines prioritized urgent renal cancer surgeries and recommended delaying systemic therapies when possible. The pandemic's impact on renal cancer diagnosis and treatment patterns remained unclear, prompting this population-based study.

Data Highlights

Key Findings

• There was a 30% initial decline in RCC diagnoses during the first COVID-19 wave, primarily affecting early-stage (T1a/T1b) tumors and patients over 70 years old.
• The overall number of RCC diagnoses in 2020 was 10% lower than expected based on 2018/2019 data, with recovery to baseline levels in 2021.
• T1a RCC patients during the 2nd COVID period were more likely to receive no active treatment (36.2% vs. 30.8%) and less likely to undergo radical nephrectomy (9.6% vs. 13.8%) compared to pre-pandemic years.
• There was an increased use of radiotherapy in 2021, likely reflecting evolving clinical practice rather than a direct COVID-19 effect.
• Guideline recommendations to prioritize radical nephrectomies within 6 weeks were maintained, while partial nephrectomies and focal therapies were deprioritized during capacity constraints.

Clinical Implications

Clinicians should be aware that the COVID-19 pandemic caused delays and reductions in renal cancer diagnoses, particularly for early-stage disease and elderly patients, potentially impacting outcomes. Treatment adaptations, including increased non-active management and shifts away from surgery, highlight the need for careful patient selection and follow-up. Restoration of diagnostic and treatment services is critical to avoid long-term negative effects on renal cancer care.

Conclusion

The COVID-19 pandemic significantly disrupted renal cancer diagnosis and management in the Netherlands during 2020, with a notable decline in early-stage diagnoses and altered treatment patterns. By 2021, diagnosis rates normalized, underscoring healthcare system resilience but emphasizing the importance of maintaining cancer care access during crises.

References

1. Dutch National COVID-19 Data 2020 -- First COVID-19 patient and lockdown timeline
2. Dutch Cancer Registry Reports 2020-2021 -- Impact of COVID-19 on cancer diagnoses
3. Dutch Urological Association Guidelines 2020 -- Renal cancer surgical prioritization
4. Dutch Association of Medical Oncology Recommendations 2020 -- Systemic therapy adjustments
5. Netherlands Cancer Registry 2018-2021 -- Renal cancer patient data