Impact of the COVID-19 pandemic on diagnosis, and healthcare utilization, among patients with cancer (lung, breast, and pancreas) and cardiovascular diseases (HF, AF, hypertensive, and chronic ischemic heart disease) in Germany: two systematic reviews.

TL;DR

A systematic review of German healthcare data found that hospital admissions for cancer and cardiovascular disease dropped substantially during the pandemic, with new cancer diagnoses falling up to 25% during lockdowns, but evidence on long-term mortality and treatment outcomes remains sparse .

What the Study Found

German healthcare systems experienced measurable disruptions to routine diagnosis and treatment during COVID-19, according to this comprehensive systematic review published in Systematic Reviews. Researchers searched major medical databases for studies documenting changes in cancer diagnoses, cardiovascular disease management, and healthcare utilization between 2020-2023 compared to pre-pandemic baseline years (2018-2019). The review included 9 studies focused on cancer and 10 examining cardiovascular conditions, making it one of the most systematic assessments of pandemic-related diagnostic delays in a single healthcare system.

For cancer specifically, the findings suggest a substantial reduction in disease detection during lockdown periods. Several included studies reported relative drops in new breast and lung cancer diagnoses of up to 25% during the strictest intervention phases. Hospital admissions for cancer patients declined by up to 9% during the pandemic. These reductions likely reflect both delayed healthcare seeking among patients (due to fear of COVID exposure, restricted access to screening services, or overwhelmed hospital systems) and reduced screening activity (mammography programs, colonoscopies, and imaging studies were often postponed). Pancreatic cancer, included in the review, showed less consistent reporting across studies, limiting conclusions about this particularly lethal malignancy.

Cardiovascular disease diagnoses and admissions also dropped significantly during peak pandemic periods. Hospital admissions for atrial fibrillation/flutter and heart failure fell by up to 20%, with the steepest declines coinciding with pandemic waves. Admissions for hypertensive crises and chronic ischemic heart disease were documented in fewer studies, reducing the certainty of estimates for these conditions. What makes these findings notable is that they suggest fewer people were seeking care or being diagnosed, not necessarily that disease incidence dropped. Cardiovascular conditions don't spontaneously resolve due to lockdowns, so reduced admissions likely represent unmet medical need rather than improved population health.

A critical limitation of this review is the scarcity of data on downstream consequences. Evidence on treatment delays, changes in treatment intensity, and mortality outcomes during and after the pandemic was "limited" according to the authors. The review identified substantial heterogeneity across studies in how outcomes were measured and reported, making it difficult to generate precise pooled estimates. Several conditions, particularly pancreatic cancer and some cardiovascular diagnoses, had inadequate reporting across included studies. The authors explicitly note that while admission and diagnosis reductions are well-documented, "the full pandemic's impact" cannot be comprehensively assessed with current evidence. This gap between documented access disruptions and unknown health consequences is a key takeaway: we know diagnoses were missed, but we don't yet know how many patients experienced delayed treatment, progression to advanced disease stages, or excess mortality as a result.

What This Means for You

This review documents a real healthcare system failure during an acute crisis, with measurable consequences for disease detection. If you were diagnosed with cancer or a heart condition after 2020, consider asking your healthcare provider whether your disease stage or severity might have been affected by pandemic-related delays. The data suggests the highest-risk period was during strict lockdowns in 2020-2021.

For ongoing health management, the review reinforces that healthcare system resilience matters for your outcomes. Routine screening (mammography, blood pressure monitoring, electrocardiograms) provides early warning for serious conditions. If you've postponed medical appointments during or after the pandemic, this evidence suggests completion of those visits may be particularly valuable. Conversely, if you experienced heart symptoms or concerning signs during pandemic lockdown periods when hospital admissions dropped, you may have been affected by reduced access to emergency care.

The gap in mortality data is important context. Reduced diagnoses do not necessarily mean reduced long-term harm if delayed treatments remain effective, though late-stage cancer and advanced heart disease generally have worse prognoses. This review alone cannot establish that the diagnostic delays translated to excess deaths, but the circumstantial evidence (fewer diagnoses, later disease stages at detection) suggests elevated risk.

Study Details

Sources

Weibel S, et al. Impact of the COVID-19 pandemic on diagnosis, and healthcare utilization, among patients with cancer (lung, breast, and pancreas) and cardiovascular diseases (HF, AF, hypertensive, and chronic ischemic heart disease) in Germany: two systematic reviews. Syst Rev. 2024. PubMed: 42169206