Analysis of the impact of the first COVID-19 wave on head and neck cancer care in the Netherlands

May 2022 Covid-19 Willem van Altena

Researchers in the Netherlands have analysed the impact of the COVID-19 pandemic on diagnosis and treatment of head and neck cancer (HNC). As expected, a lower incidence of HNC was reported during the first COVID wave in early 2020, mainly in oral cavity and laryngeal cancer. However, after the first COVID wave, when non-COVID care resumed its normal pattern, the expected increase in incidence was not observed.

HNC care in the Netherlands is centralised at eight head and neck oncology centres (HNOCs) and six preferred partner hospitals. As almost all these fourteen specialised hospitals were also key healthcare providers for COVID-19 patients, the best way of allocating the limited resources between COVID-19 and cancer patients was sometimes a difficult dilemma.

Study design

The researchers conducted a population-based study that covered all, in total 8,468, newly diagnosed primary HNC cases in the Netherlands from the Dutch National Cancer Registry in 2018, 2019 and 2020. This selection included squamous cell carcinoma of pharynx, larynx, or oral cavity as well as salivary gland cancers, nasal cavity carcinoma and cervical lymph node metastasis of squamous cell cancer of an unknown primary tumour (CUP). Excluded were those with in situ carcinomas, recurrent malignancy or any synchronous primary tumour in the head and neck region, as well as patients with cutaneous malignancies, sarcomas, neuroendocrine cancers or lymphomas in the head and the neck region, and also those with thyroid carcinomas.
Comparisons were made for incidence, patient and tumour characteristics, primary treatment characteristics, and time-to-treatment in the first COVID-19 year 2020 with corresponding periods in the pre-COVID years 2018 and 2019.


During the first wave of the pandemic (between 15 March and 1 June 2020), nearly 25% fewer diagnoses of HNC were made, namely 433. During the same period in 2019 this was 595, and in 2018 it was 598. Most notably in April and May 2020, the incidence of oral cavity and laryngeal carcinomas was significantly lower than in pre-COVID years. There were no shifts in tumour stage or alterations in initial treatment modalities.
Treatments were started sooner during the first wave of the pandemic than in earlier years. The proportion of patients starting treatment within 30 days increased significantly from 48.8% pre-COVID to 67.6% during COVID (p < 0.001). The median time to treatment interval (TTI) also decreased, from 37 days pre-COVID to 30 days during the first outbreak (p < 0.001), whereas the number of excluded patients due to a TTI of zero days did not differ (n = 26 (7.1%) during COVID and n = 77 (7.6%) pre-COVID). Regardless of the first treatment modality and specific period, the median number of days between first visit to a HNC centre and start of treatment was significantly shorter during the COVID-19 year (26–28 days) than pre-COVID (31–32 days, p < 0.001).


The incidence of HNC during the Netherlands’ first COVID-19 wave between 15 March and 1 June 2020 was significantly lower than expected. The expected increase in incidence during the remainder of 2020 was not observed. Despite the overloaded healthcare system, the standard treatment for HNC patients could be delivered within a shorter time interval.


Schoonbeek RC, de Jel DVC, van Dijk BAC, et al; Dutch Head, Neck Society, the COVID, Cancer-NL consortium. Fewer head and neck cancer diagnoses and faster treatment initiation during COVID-19 in 2020: A nationwide population-based analysis. Radiother Oncol. 2022 Feb;167:42-48.