An umbrella review of systematic reviews on the impact of the COVID-19 pandemic on cancer prevention and management, and patient needs
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eLife assessment
This convincing work reviews and synthesizes evidence of the impact of the COVID-19 pandemic on a variety of cancer outcomes. The results have potentially useful implications for various fields of cancer research as they review evidence spanning from cancer prevention efforts to changes in diagnoses and cancer treatment modalities.
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Abstract
The relocation and reconstruction of health care resources and systems during the coronavirus disease 2019 (COVID-19) pandemic may have affected cancer care. An umbrella review was undertaken to summarize the findings from systematic reviews on impact of the COVID-19 pandemic on cancer treatment modification, delays, and cancellations; delays or cancellations in screening and diagnosis; psychosocial well-being, financial distress, and use of telemedicine as well as on other aspects of cancer care. Bibliographic databases were searched for relevant systematic reviews with or without meta-analysis published before November 29th, 2022. Abstract, full- text screening, and data extraction were performed by two independent reviewers. AMSTAR-2 was used for critical appraisal of included systematic reviews. Fifty-one systematic reviews were included in our analysis. Most reviews were based on observational studies judged to be at medium and high risk of bias. Only two reviews had high or moderate scores based on AMSTAR-2. Findings suggest treatment modifications in cancer care during the pandemic versus the pre-pandemic period were based on low level of evidence. Different degrees of delays and cancellations in cancer treatment, screening, and diagnosis were observed, with low- and- middle- income countries and countries that implemented lockdowns being disproportionally affected. A shift from in-person appointments to telemedicine use was observed, but utility of telemedicine, challenges in implementation and cost-effectiveness in cancer care were little explored. Evidence was consistent in suggesting psychosocial well-being of patients with cancer deteriorated, and cancer patients experienced financial distress, albeit results were in general not compared to pre-pandemic levels. Impact of cancer care disruption during the pandemic on cancer prognosis was little explored. In conclusion, substantial but heterogenous impact of COVID-19 pandemic on cancer care has been observed.
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Author Response
Reviewer #1 (Public Review):
This umbrella review aims to synthesize the results of systematic reviews of the impact of the COVID-19 pandemic on various dimensions of cancer care from prevention to treatment. This is a challenging endeavor given the diversity of outcomes that can be assessed in cancer care.
Search and review methods are good and are in line with recommendations for umbrella reviews. Perhaps one weakness of the search strategy was that only one database (Pubmed) was searched. The search strategy appears adequate, though perhaps some more search terms related to reviews and cancer could have been included. It is therefore possible that some reviews may have been missed by the search strategy.
It is challenging to perform a good umbrella review that yields novel insights, as it is difficult to …
Author Response
Reviewer #1 (Public Review):
This umbrella review aims to synthesize the results of systematic reviews of the impact of the COVID-19 pandemic on various dimensions of cancer care from prevention to treatment. This is a challenging endeavor given the diversity of outcomes that can be assessed in cancer care.
Search and review methods are good and are in line with recommendations for umbrella reviews. Perhaps one weakness of the search strategy was that only one database (Pubmed) was searched. The search strategy appears adequate, though perhaps some more search terms related to reviews and cancer could have been included. It is therefore possible that some reviews may have been missed by the search strategy.
It is challenging to perform a good umbrella review that yields novel insights, as it is difficult to combine results from different reviews which themselves combine results from different studies with different methodologies. However, I think perhaps one of the main weaknesses of this study is that it is not clear to me what is the core objective of the umbrella review, and how analyses relate to that core objective. In other words, I do not understand based on the introduction what new information the authors are hoping to learn from their umbrella review that could not be learned from reading the individual systematic reviews, beyond a vague objective of "synthesizing" the literature. Because of this, it is not very clear to me how the data extracted and the analysis fits into the larger objectives, and what the new knowledge generated by this review is. Based on the reported results, it would appear that one of the main goals is to assess the quality of systematic reviews and of the underlying studies in the reviews, but it is hard to tell. I think there are potentially important insights this review could tell us, but the message and implications of current evidence remain for me a little confused in the current manuscript.
We thank the reviewer for the encouraging remarks on our work, and for the useful feedback. We have now addressed all concerns as outline below.
Reviewer #2 (Public Review):
This umbrella review summarizes the results of systematic reviews about the impact of the COVID-19 pandemic on cancer care. PRISMA checklist is used for reporting. The literature search was performed in PubMed and systematic reviews published until November 29th, 2022 were included. The quality of included systematic reviews was appraised using the AMSTAR-2 tool and data were reported descriptively due to the high heterogeneity of 45 included studies. Based on the results of this paper, regardless of the low quality of included evidence, COVID-19 affected cancer care in many ways including delay and postponement of cancer screening, diagnosis, and treatment. Also, patients with cancer had been affected psychologically, socially, and financially during the COVID-19 pandemic.
The main limitation of the current study is that the authors have searched only one database, which might have missed some relevant systematic reviews. Also, most of the included reviews in this paper had low and medium methodological quality.
We thank the reviewer for this excellent remark. Guideline on umbrella reviews suggest PubMed, reference screening and an additional bibliographic database for an optimal database combination for searching systematic reviews (Goossen K et al. 2020). To follow the guidelines, and considering the specialized focused on COVID-19, in addition to Pubmed and reference screening, we also performed a search in the WHO COVID-19 Database. Furthermore, we revised the search strategy in Pubmed to include mesh terms. The search was performed by a specialized librarian with experiences in systematic review searches. Overall, we retrieve 485 new references, and found 6 new studies that met out inclusion criteria to be included in final analysis. We have now revised the manuscript to reflect the above changes, and also highlighted this as a strength of our work. In addition, we added the new detailed search strategy in the supplemental material.
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eLife assessment
This convincing work reviews and synthesizes evidence of the impact of the COVID-19 pandemic on a variety of cancer outcomes. The results have potentially useful implications for various fields of cancer research as they review evidence spanning from cancer prevention efforts to changes in diagnoses and cancer treatment modalities.
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Reviewer #1 (Public Review):
This umbrella review aims to synthesize the results of systematic reviews of the impact of the COVID-19 pandemic on various dimensions of cancer care from prevention to treatment. This is a challenging endeavour given the diversity of outcomes that can be assessed in cancer care.
Search and review methods are good and are in line with recommendations for umbrella reviews. Perhaps one weakness of the search strategy was that only one database (Pubmed) was searched. The search strategy appears adequate, though perhaps some more search terms related to reviews and cancer could have been included. It is therefore possible that some reviews may have been missed by the search strategy.
It is challenging to perform a good umbrella review that yields novel insights, as it is difficult to combine results from …
Reviewer #1 (Public Review):
This umbrella review aims to synthesize the results of systematic reviews of the impact of the COVID-19 pandemic on various dimensions of cancer care from prevention to treatment. This is a challenging endeavour given the diversity of outcomes that can be assessed in cancer care.
Search and review methods are good and are in line with recommendations for umbrella reviews. Perhaps one weakness of the search strategy was that only one database (Pubmed) was searched. The search strategy appears adequate, though perhaps some more search terms related to reviews and cancer could have been included. It is therefore possible that some reviews may have been missed by the search strategy.
It is challenging to perform a good umbrella review that yields novel insights, as it is difficult to combine results from different reviews which themselves combine results from different studies with different methodologies. However, I think perhaps one of the main weaknesses of this study is that it is not clear to me what is the core objective of the umbrella review, and how analyses relate to that core objective. In other words, I do not understand based on the introduction what new information the authors are hoping to learn from their umbrella review that could not be learned from reading the individual systematic reviews, beyond a vague objective of "synthesizing" the literature. Because of this, it is not very clear to me how the data extracted and the analysis fits into the larger objectives, and what the new knowledge generated by this review is. Based on the reported results, it would appear that one of the main goals is to assess the quality of systematic reviews and of the underlying studies in the reviews, but it is hard to tell. I think there are potentially important insights this review could tell us, but the message and implications of current evidence remain for me a little confused in the current manuscript.
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Reviewer #2 (Public Review):
This umbrella review summarizes the results of systematic reviews about the impact of the COVID-19 pandemic on cancer care. PRISMA checklist is used for reporting. The literature search was performed in PubMed and systematic reviews published until November 29th, 2022 were included. The quality of included systematic reviews was appraised using the AMSTAR-2 tool and data were reported descriptively due to the high heterogeneity of 45 included studies. Based on the results of this paper, regardless of the low quality of included evidence, COVID-19 affected cancer care in many ways including delay and postponement of cancer screening, diagnosis, and treatment. Also, patients with cancer had been affected psychologically, socially, and financially during the COVID-19 pandemic.
Strengths:
This umbrella review …
Reviewer #2 (Public Review):
This umbrella review summarizes the results of systematic reviews about the impact of the COVID-19 pandemic on cancer care. PRISMA checklist is used for reporting. The literature search was performed in PubMed and systematic reviews published until November 29th, 2022 were included. The quality of included systematic reviews was appraised using the AMSTAR-2 tool and data were reported descriptively due to the high heterogeneity of 45 included studies. Based on the results of this paper, regardless of the low quality of included evidence, COVID-19 affected cancer care in many ways including delay and postponement of cancer screening, diagnosis, and treatment. Also, patients with cancer had been affected psychologically, socially, and financially during the COVID-19 pandemic.
Strengths:
This umbrella review has summarized many important aspects of cancer care that were affected during the COVID-19 pandemic.
Weakness:
The main limitation of the current study is that the authors have searched only one database, which might have missed some relevant systematic reviews. Also, most of the included reviews in this paper had low and medium methodological quality.
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