OBJECTIVES: The number of new cancer diagnoses sharply dropped during the COVID-19 pandemic. This raises concerns of missed and delayed cancer diagnoses. We aimed to compare trends in the incidence of early and late-stage disease and utilisation of systemic anticancer treatment using nationwide datasets in England.

METHODS: Data from two datasets identified changes in trends of diagnosis of cancer (NCRAS nationwide cancer registry dataset between January 2018 and January 2023) and prescriptions of late-stage cancer therapies (The Secondary Care Medicines dataset between January 2019 and December 2022). Medicines were classified as late-stage based on clinical and literature review. Monthly rates of new cancer diagnoses and prescription doses per 100 people in England were estimated. Missed diagnoses were estimated by comparing the observed values to the projected pre-covid trend.

RESULTS: Diagnoses of early and late-stage cancers substantially decreased after the onset of the pandemic with rates not returning to pre-pandemic trends until August and March 2021, respectively. There were an estimated 62,599 fewer early-stage, 26,026 late-stage cancer diagnoses between April 2020 and December 2022 and an estimated additional 23,943 unknown stage cancer diagnoses between April 2020 and December 2022. Of 194 cancer therapies, 76 were identified for the treatment of late-stage cancer. Prescriptions for late-stage cancer therapies dropped at the onset of the pandemic 100 individuals, rebounding to pre-pandemic levels by October 2020. By December 2022, the rates had increased past pre-pandemic levels, reaching 5.4 per 100 individuals.

CONCLUSIONS: The use of late-stage cancer therapies has risen although this does not appear to be the result of more late-stage cancer diagnoses. The falls in early-stage cancer diagnoses during the pandemic raises the prospect of more patients presenting with late-stage cancer in the future, potentially being a contributing factor for the increased use of late-stage therapies post-pandemic.