Follow up study of the impact of COVID-19 epidemic on cancer burden and care in Slovenia


  • Tina Zagar
  • Sonja Tomšič
  • Vesna Zadnik
  • Nika Bric
  • Mojca Birk
  • Blaž Vurzer
  • Ana Mihor
  • Katarina Lokar
  • Irena Oblak


Background. In Slovenia, oncological services were exempt from government decrees for COVID-19 containment. Nevertheless, cancer management depends also on other health services and changes in people’s behaviour further impact the cancer burden. In this follow up study, we explored changes in cancer burden and care beyond the first wave of the epidemic.

Methods. We analysed routinely collected data for the period January 2019 through July 2022 from three sources: (1) pathohistological and clinical practice cancer notifications from two major cancer centres in Ljubljana and Maribor (source: Slovenian Cancer Registry); (2) referrals issued for oncological services (source: e-referral system); and (3) outpatient visits and diagnostic imaging performed (source: administrative data of the Institute of Oncology Ljubljana – IOL). Additionally, changes in certain characteristics in patients diagnosed and treated during the epidemic were analysed using the Hospital-Based Cancer Registry of the IOL (period 2015–2021).

Results. In June-August 2020, there was an increase in referrals for control oncology examinations, but it did not make-up for the drop in the first wave; the numbers in 2021 and 2022 were even lower than 2020. Demands for first oncological examinations and genetic testing and counselling increased in 2021 compared to 2019 and in 2022 increased further by more than a quarter. First and control outpatient visits and cancer diagnostic imaging at the IOL dropped after the onset of the epidemic in March 2020 but were as high as expected already in 2021. Some deficits remain for control outpatients visits in surgical and radiotherapy departments. There were more CT, MRI and PET-CT scans performed during the COVID-19 period than before. New cancer diagnoses dropped in all observed years 2020, 2021 and until July 2022 by 6%, 3% and 8%, respectively, varying substantially by cancer site. The largest drop was seen in the 50−64 age group (almost 14% in 2020 and 16% in 2021), while for patients older than 80 years, the numbers were above expected (4% in 2020, 8% in 2021).

Conclusions. Our results show a varying effect of COVID-19 epidemic in Slovenia for different cancers and at different levels of the patient-care pathway – it is probably a mixture of personal behavioural changes and systemic changes due to modifications in healthcare organisation on account of COVID-19. A general drop in new cancer cases reflects disruptions in the pre-diagnostic phase and could have profound long-term consequences on cancer burden indicators.




How to Cite

Zagar, T., Tomšič, S., Zadnik, V., Bric, N., Birk, M., Vurzer, B., … Oblak, I. (2022). Follow up study of the impact of COVID-19 epidemic on cancer burden and care in Slovenia. Radiology and Oncology, 56(4), 488–500. Retrieved from



Clinical oncology