Neuroendocrine tumors (NETs) are cancers that begin in the cells that release hormones into the bloodstream. NETs can occur anywhere in the body, and most develop slowly and may not cause symptoms in the early stages. During the Covid-19 pandemic, oncology teams had to restructure their approach to treatment due to staff taking time off because of the pandemic. As a result of staff shortages and the impact of strict lockdowns in several countries, oncology centers had to pivot their approach to telehealth. In Europe, Italy had one of the longest and strictest lockdowns at the start of the pandemic. The prolonged lockdown in Italy resulted in NET inpatient and outpatient care being disrupted, and this is likely to be the case in other countries that experience long and strict lockdowns.

A survey study in Italy, published in the Journal of Endocrinological Investigation, assessed the impact of the Covid-19 pandemic on the care for NET patients. The 57-question survey was sent to several NET-dedicated centers and found that several aspects of care were modified. There was a decrease in newly diagnosed patients between March 2020 and May 2020, down 76.8% compared with the usual number of diagnoses per month. This means that the diagnosed incidence of NETs in Italy may decrease in the short term. Surgical procedures decreased by 58% compared with the number of procedures carried out before the pandemic.

Overall, the survey found that 26% of NET centers experienced postponed or canceled follow-up examinations and that slightly over 20% of team meetings were canceled. Enrollment in clinical trials decreased in 50% of NET centers. A different survey, published in the Journal of Clinical Medicine, conducted in Austria, Switzerland, and Germany, found that less than 25% of patient appointments were canceled in participating NET centers, so when comparing these results to those of Italy, we can see that the stronger impact of Covid-19 in Italy than in German-speaking European countries led to more appointment cancellations. In Italy, approximately 90% of the centers that participated in the survey experienced delays in imaging procedures. The survey of German-speaking European countries found that 50% of university hospitals experienced delays in imaging procedures. The extended and strict lockdown in Italy also affected treatment initiation, with over 45% of centers experiencing delays in starting peptide receptor radionuclide therapy (PRRT), whereas university hospitals in Austria, Switzerland, and Germany reported no major delays for PRRT.

Although the Covid-19 pandemic in Italy has led several centers to reduce important activities in the management of NET patients, the Italian network was able to provide continuity in care without withdrawing anti-tumor treatment in the majority of its patients. The diagnosis delays in Italy, Austria, Switzerland, and Germany will have a negative impact by reducing the probability of patients receiving curative surgery for early-stage disease. In Italy, the delay in the initiation of an effective antitumor medical therapy in those patients with more advanced disease may lead to decreased survival. The findings of these survey studies show how NET diagnosis and treatment is adversely affected by strict and prolonged lockdowns in countries experiencing high levels of community transmission and large numbers of Covid-19 cases.

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