Impact of the COVID-19 pandemic on diagnosis, and healthcare utilization, among patients with cancer (lung, breast, and pancreas) and cardiovascular diseases (HF, AF, hypertensive, and chronic ischemic heart disease) in Germany: two systematic reviews.
Ropeter J, Overhageböck N, et al. • Systematic reviews • 2026
The COVID-19 pandemic was associated with substantial reductions in hospital admissions and new diagnoses among patients with cancer and cardiovascular disease in Germany, suggesting major disruptions to care delivery.
Key Findings
Results
New breast and lung cancer diagnoses were reduced by up to 25% during lockdown periods in Germany.
Several studies reported a relative reduction in new breast and lung cancer diagnoses of up to 25% during lockdown periods.
9 cancer studies were included after screening 1,991 records.
Cancer types assessed included breast, lung, and pancreatic cancer.
The comparison period was pandemic years 2020–2023 versus pre-pandemic period 2018–2019.
Findings were synthesized narratively due to heterogeneity across studies.
Results
Hospital admissions for cancer patients decreased by up to 9% during the pandemic in Germany.
The decrease in hospital admissions of up to 9% was observed across the included cancer studies.
Studies covered breast, lung, and pancreatic cancer diagnoses.
Risk of bias was assessed using an adapted ROBINS-E tool.
Evidence on treatment delays, changes in treatment, and mortality was described as limited.
Results
Hospital admissions for atrial fibrillation/flutter and heart failure decreased by up to 20% during pandemic peaks in Germany.
Reductions were particularly pronounced during pandemic peaks.
10 cardiovascular studies were included after screening 4,981 records.
Cardiovascular conditions assessed included atrial fibrillation/flutter, heart failure, hypertensive heart disease, and chronic ischemic heart disease.
Outcomes for some included diagnoses were often not reported in the available studies.
Findings were synthesized narratively due to heterogeneity.
Results
Evidence on treatment delays, changes in treatment, and disease-specific mortality during the pandemic was limited across both cancer and cardiovascular conditions.
The authors noted that 'evidence on treatment delays, changes in treatment, and mortality was limited.'
Outcomes for several included diagnoses were 'often not reported' in the available studies.
Heterogeneity and gaps in the evidence base limited a comprehensive assessment of downstream outcomes.
The review covered the pandemic period from 2020 to 2023.
Methods
Two systematic reviews were conducted following PRISMA guidelines, with protocols registered in PROSPERO, covering cancer and cardiovascular disease impacts separately.
Databases searched included PubMed, Web of Science, Cochrane Library, Scopus, and Embase, with grey literature also screened.
Two reviewers independently screened records, extracted data, and assessed risk of bias using an adapted ROBINS-E tool.
A total of 1,991 records were screened for cancer and 4,981 for cardiovascular diseases.
9 cancer studies and 10 cardiovascular studies were ultimately included.
Narrative synthesis was used due to heterogeneity across included studies.
Background
Non-pharmaceutical interventions such as lockdowns and contact restrictions were identified as factors disrupting routine healthcare delivery for cancer and cardiovascular disease patients in Germany.
NPIs included lockdowns and contact restrictions.
These measures 'affected diagnostic and treatment services for people with cancer and cardiovascular diseases, potentially delaying diagnosis and adversely influencing outcomes.'
The authors called for 'more comprehensive, linked data and further research' to quantify the full pandemic impact.
The review also aimed to inform health-system resilience for future crises.
What This Means
This research suggests that the COVID-19 pandemic caused significant disruptions to medical care for people with cancer (breast, lung, and pancreatic) and cardiovascular diseases (such as heart failure and atrial fibrillation) in Germany. Through two systematic reviews combining data from multiple studies, the researchers found that new cancer diagnoses dropped by as much as 25% and hospital admissions for cancer fell by up to 9% during lockdown periods. For heart conditions, hospital admissions fell by as much as 20%, especially during the peaks of the pandemic. These reductions likely reflect people avoiding hospitals and clinics during lockdowns, as well as the healthcare system being redirected toward COVID-19 care.
However, the research also highlights important gaps in what is currently known. There was very limited evidence available on whether treatments were delayed, how treatment patterns changed, or whether death rates from these diseases increased as a result of the pandemic disruptions. The studies included were also quite varied in their methods and focus, making it difficult to draw firm overall conclusions.
This research suggests that pandemics and large-scale public health crises can have serious unintended consequences for patients with chronic and serious illnesses, beyond those directly infected. The authors emphasize the need for better-linked health data systems in Germany to fully understand these effects and to help health systems prepare for and respond more effectively to future public health emergencies.
Ropeter J, Overhageböck N, Dreier M, Meyerdierks D, Imran A, Heinsohn T, et al.. (2026). Impact of the COVID-19 pandemic on diagnosis, and healthcare utilization, among patients with cancer (lung, breast, and pancreas) and cardiovascular diseases (HF, AF, hypertensive, and chronic ischemic heart disease) in Germany: two systematic reviews.. Systematic reviews. https://doi.org/10.1186/s13643-026-03192-z