Incident Cancer Detection During Multiple Waves of COVID-19: The Tsunami After the Earthquake

Authors: Rui Fu PhD1,2,3, Rinku Sutradhar PhD1,2, Qing Li MMath1, Timothy P. Hanna MD, PhD4,5, Kelvin K.W. Chan MD, PhD6,7, Jonathan C. Irish MD, MSc2,8, Natalie Coburn MD, MPH1,2,7,9, Julie Hallet MD, MSc1,2,6,9, Anna Dare MBChB, PhD1,2,9, Simron Singh MD, MPH1,2,10, Ambica Parmar MD, MSc1,10, Craig C. Earle MD, MSc1,10, Lauren Lapointe-Shaw MD, PhD1,2,10, Monika K. Krzyzanowska MD, MPH1,2,10, Antonio Finelli MD, MSc1,2,9, Alexander V. Louie MD, PhD11, Nicole J. Look Hong MD, MSc1,2,9, Ian J. Witterick MD, MSc3,7,8, Alyson Mahar PhD12, David Gomez MD, PhD1,2,9,13, Daniel I. McIsaac MD, MPH1,14, Danny Enepekides MD, MPH3, David R. Urbach MD, MSc1,15, and Antoine Eskander MD, ScM1,2,3
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  • 1 ICES, Toronto, Ontario;
  • | 2 Institute of Health Policy, Management, and Evaluation, and
  • | 3 Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto;
  • | 4 Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen’s University, Kingston;
  • | 5 Ontario Institute for Cancer Research (OICR), Toronto;
  • | 6 Odette Cancer Centre–Sunnybrook Health Sciences Centre, Toronto;
  • | 7 Ontario Health–Cancer Care Ontario, Toronto;
  • | 8 Department of Otolaryngology–Head & Neck Surgery/Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto;
  • | 9 Department of Surgery,
  • | 10 Department of Medicine, and
  • | 11 Department of Radiation Oncology, University of Toronto, Toronto;
  • | 12 School of Nursing, Queen’s University, Kingston;
  • | 13 Division of General Surgery, St. Michael’s Hospital, Unity Health Toronto, Toronto;
  • | 14 Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa; and
  • | 15 Department of Surgery, Women’s College Hospital, Toronto, Ontario, Canada.

No population-based study exists to demonstrate the full-spectrum impact of COVID-19 on hindering incident cancer detection in a large cancer system. Building upon our previous publication in JNCCN, we conducted an updated analysis using 12 months of new data accrued in the pandemic era (extending the study period from September 26, 2020, to October 2, 2021) to demonstrate how multiple COVID-19 waves affected the weekly cancer incidence volume in Ontario, Canada, and if we have fully cleared the backlog at the end of each wave.

Submitted August 29, 2022; accepted for publication September 15, 2022.

Disclosures: Dr. Eskander has disclosed receiving grant/research support from Merck and serving as a consultant for Bristol Myers Squibb. Dr. Hallet has disclosed receiving honoraria from Ipsen Biopharmaceuticals and Novartis Canada. The remaining authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Funding: This work was supported by a Sunnybrook Research Institute and Sunnybrook Foundation COVID-19 Response Grant and a Canadian Institutes of Health Research Operating Grant #179892.

Disclaimer: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Correspondence: Antoine Eskander, MD, ScM, University of Toronto, 2075 Bayview Avenue, M1-102, Toronto, Ontario, Canada M4N 3M5. Email:
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