{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T06:13:34Z","timestamp":1785564814958,"version":"3.56.0"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,9,20]],"date-time":"2023-09-20T00:00:00Z","timestamp":1695168000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>During the first wave of the COVID-19 pandemic in 2020, non-essential health services were suspended in Belgium, and the public was ordered to socially isolate. Underdiagnosis of cancer during this period was reported worldwide. Certain risk factors for head and neck cancer (HNC) overlap with those for COVID-19 incidence and mortality, making underdiagnosis and subsequent stage shift of this potentially rapidly progressing cancer a major concern. We aimed to analyze incidence, clinical stage at presentation, and survival of patients diagnosed with HNC in 2020 in Belgium, considering recent temporal trends.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Using population-based data from the Belgian Cancer Registry (BCR), we extrapolated 2017-2019 trends in incidence, clinical stage, and 1-year relative survival (1yRS) of HNC to create an expected value for 2020 and compared this to the observed value.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 9.5% fewer HNCs diagnosed in 2020, compared to the predicted incidence. Underdiagnosis was larger for males (-11.8%), patients aged 50-64 (-11.2%) and 65-79 (-11.1%), and for oral cavity cancer (-17.6%). Shifts to more advanced stages were observed in larynx and oropharynx tumors and for (male) patients aged 80+. A 2.4 percentage point decline in 1yRS was observed, relative to the increasing trends in 1yRS (2017-2019).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The COVID-19 pandemic led to underdiagnosis of HNC, resulting in shifts to more advanced stage at presentation in certain subgroups. A stage shift can be expected for the 9.5% of tumors not yet diagnosed at the end of 2020. HNC patients diagnosed in 2020 suffered higher than expected mortality.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fonc.2023.1253968","type":"journal-article","created":{"date-parts":[[2023,9,21]],"date-time":"2023-09-21T08:38:07Z","timestamp":1695285487000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":16,"title":["Stage shift and relative survival for head and neck cancer during the 2020 COVID-19 pandemic: a population-based study of temporal trends"],"prefix":"10.3389","volume":"13","author":[{"given":"Hanna M.","family":"Peacock","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cindy","family":"De Gendt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geert","family":"Silversmit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"Nuyts","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Casselman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Pascal","family":"Machiels","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Giusti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bart","family":"van Gool","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Vander Poorten","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liesbet","family":"Van Eycken","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,9,20]]},"reference":[{"key":"B1","unstructured":"Covid-19 Surveillance Frequently Asked Questions2022"},{"key":"B2","unstructured":"CEORL-HNS Statement to COVID-192020"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.5152\/B-ENT.2021.20183","article-title":"Ear, nose, and throat service during the COVID-19 pandemic: a cross-sectional study","volume":"16","author":"Peigneux","year":"2021","journal-title":"B-Ent"},{"key":"B4","doi-asserted-by":"publisher","first-page":"100197","DOI":"10.1016\/j.esmoop.2021.100197","article-title":"Decline and incomplete recovery in cancer diagnoses during the COVID-19 pandemic in Belgium: a year-long, population-level analysis","volume":"6","author":"Peacock","year":"2021","journal-title":"ESMO Open"},{"key":"B5","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1016\/j.radonc.2007.04.001","article-title":"Tumor progression in waiting time for radiotherapy in head and neck cancer","volume":"84","author":"Jensen","year":"2007","journal-title":"Radiother Oncol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1002\/hed.26665","article-title":"The impact of COVID-19 on head and neck cancer diagnosis and disease extent","volume":"43","author":"Kiong","year":"2021","journal-title":"Head Neck"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1002\/hed.26858","article-title":"Treatment delay and tumor size in patients with oral cancer during the first year of the COVID-19 pandemic","volume":"43","author":"Metzger","year":"2021","journal-title":"Head Neck"},{"key":"B8","doi-asserted-by":"publisher","first-page":"2473974X211068075","DOI":"10.1177\/2473974X211068075","article-title":"The impact of COVID-19 on head and neck cancer treatment: before and during the pandemic","volume":"5","author":"Solis","year":"2021","journal-title":"OTO Open"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-021-06728-2","article-title":"Delayed presentation of head and neck cancer patients during COVID-19 pandemic","volume":"278","author":"Tevetoglu","year":"2021","journal-title":"Eur Arch Otorhinolaryngol"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.26744","article-title":"Effects of the COVID-19 pandemic on head and neck cancer stage and treatment duration","volume":"14","author":"Kourtidis","year":"2022","journal-title":"Cureus"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1007\/s12070-021-03050-5","article-title":"Head and neck cancer during covid-19 pandemic: was there a diagnostic delay","volume":"74","author":"Lucidi","year":"2022","journal-title":"Indian J Otolaryngol Head Neck Surg"},{"key":"B12","doi-asserted-by":"publisher","first-page":"6385","DOI":"10.3390\/jcm11216385","article-title":"Impact of COVID-19 on head and neck cancer advancement measured by increasing numbers of urgent dyspnea cases-what could be improved in the event of subsequent pandemics","volume":"11","author":"Pietruszewska","year":"2022","journal-title":"J Clin Med"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2021.12.005","article-title":"Fewer head and neck cancer diagnoses and faster treatment initiation during COVID-19 in 2020: A nationwide population-based analysis","volume":"167","author":"Schoonbeek","year":"2022","journal-title":"Radiother Oncol"},{"key":"B14","volume-title":"Cancer Staging Data using 2018-2020 DCE Data \u2013 the impact of COVID-19","year":"2021"},{"key":"B15","volume-title":"Cancer Incidence Projections in BELGIUM 2015 to 2025","year":"2017"},{"key":"B16","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1016\/j.canep.2014.10.009","article-title":"Regional variation in incidence for smoking and alcohol related cancers in Belgium","volume":"39","author":"Henau","year":"2015","journal-title":"Cancer Epidemiol"},{"key":"B17","volume-title":"Wet Houdende Diverse Bepalingen Betreffende Gezondheid van 13 december 2006 Hoofdstuk VI Artikel 39. B.S","year":"2006"},{"key":"B18","volume-title":"TNM Classification of MALIgnant Tumours, International Union Against Cancer (UICC)","author":"Brierley","year":"2017"},{"key":"B19","volume-title":"Quality indicators for the management of head and neck squamous cell carcinoma","author":"Leroy","year":"2019"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1016\/0010-4825(92)90023-G","article-title":"Simple SAS macros for the calculation of exact binomial and Poisson confidence limits","volume":"22","author":"Daly","year":"1992","journal-title":"Comput Biol Med"},{"key":"B21","volume-title":"Instructions to IBM 650 programmers in processing survival computations","author":"Ederer","year":"1959"},{"key":"B22","unstructured":"Sterftetafels en levensverwachting2022"},{"key":"B23","unstructured":"DickmanPW\n          Estimating and modelling relative survival using SAS2004"},{"key":"B24","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1002\/sim.1597","article-title":"Regression models for relative survival","volume":"23","author":"Dickman","year":"2004","journal-title":"Stat Med"},{"key":"B25","doi-asserted-by":"publisher","first-page":"2521","DOI":"10.3390\/cancers14102521","article-title":"Sex differences in the prevalence of head and neck cancers: A 10-year follow-up study of 10 million healthy people","volume":"14","author":"Park","year":"2022","journal-title":"Cancers"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2010.02.010","article-title":"Socio-economic factors and stage at presentation of head and neck cancer patients in Ottawa, Canada: a logistic regression analysis","volume":"46","author":"Johnson","year":"2010","journal-title":"Oral Oncol"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2004.03.009","article-title":"Psychological factors and patient delay in patients with head and neck cancer","volume":"40","author":"Tromp","year":"2004","journal-title":"Eur J Cancer"},{"key":"B28","doi-asserted-by":"publisher","first-page":"8381","DOI":"10.3390\/ijerph18168381","article-title":"Dentist related factors associated with implementation of COVID-19 protective measures: A national survey","volume":"18","author":"Carvalho","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"B29","unstructured":"Ongeveer 2700 ontbrekende kankerdiagnoses in de eerste twee jaar van de COVID-19-pandemie in Belgi\u00eb2022"},{"key":"B30","volume-title":"ICD-10: international statistical classification of diseases and related health problems","year":"2004"},{"key":"B31","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1186\/s13690-022-00856-9","article-title":"The association between area deprivation and COVID-19 incidence: a municipality-level spatio-temporal study in Belgium 2020-2021","volume":"80","author":"Meurisse","year":"2022","journal-title":"Arch Public Health"},{"key":"B32","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1016\/j.oraloncology.2016.08.014","article-title":"A cohort study into head and neck cancer mortality in Belgium, (2001-11): Are individual socioeconomic differences conditional on area deprivation","volume":"61","author":"Hagedoorn","year":"2016","journal-title":"Oral Oncol"},{"key":"B33","doi-asserted-by":"publisher","first-page":"933","DOI":"10.3390\/cancers13050933","article-title":"Socio-economic position, cancer incidence and stage at diagnosis: A nationwide cohort study in Belgium","volume":"13","author":"Rosskamp","year":"2021","journal-title":"Cancers"},{"key":"B34","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1056\/NEJMoa0912217","article-title":"Human papillomavirus and survival of patients with oropharyngeal cancer","volume":"363","author":"Ang","year":"2010","journal-title":"N Engl J Med"},{"key":"B35","volume-title":"International Classification of Diseases for Oncology","year":"2019"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2023.1253968\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,21]],"date-time":"2023-09-21T08:38:16Z","timestamp":1695285496000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2023.1253968\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,20]]},"references-count":35,"alternative-id":["10.3389\/fonc.2023.1253968"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2023.1253968","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,20]]},"article-number":"1253968"}}