Pleural mesothelioma incidence and use of systemic treatment decreased during the COVID-19 pandemic in The Netherlands

Our plain-English summary of Pleural mesothelioma incidence and use of systemic treatment decreased during the COVID-19 pandemic in The Netherlands, by I. Smesseim, L.H. Douma, J.A. Burgers, et al (Scientific Reports, 2025).

The study

• Authors: I. Smesseim, L.H. Douma, J.A. Burgers, R.A.M. Damhuis
• Journal: Scientific Reports
• Published: 2025;15(1):25677
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Pleural mesothelioma (PM) is a lethal cancer often linked to asbestos exposure. The COVID-19 pandemic caused a global health crisis, raising concerns about its impact on cancer diagnoses and treatments. In response to the immense pressures on the healthcare system caused by the COVID-19 pandemic, many countries advised prioritizing essential healthcare services while postponing or suspending care considered non-emergent to prevent overburdening healthcare systems. This study assesses the impact of COVID-19 on the incidence, treatment, and overall survival of PM patients in the Netherlands between 2018 and 2022. Data were collected from the Netherlands Cancer Registry for 2,629 PM patients. Incidence, treatment patterns, and survival rates were analyzed using statistical methods, including Kruskal-Wallis and log-rank tests. PM incidence dropped 13.2% in 2020 during the pandemic, with a 58.8% increase in patients receiving best supportive care and a decline in chemotherapy use (from 39.4% to 32.0%). In 2021, diagnoses rebounded (+ 15.2%), and immunotherapy use rose following its approval. However, no significant difference in overall survival was found between 2018 and 2022. COVID-19 led to a temporary decline in PM diagnoses and systemic treatments in 2020, followed by recovery in 2021. Despite these changes, overall survival rates remained stable.

© 2025. The Author(s).

In plain English

Using the Netherlands Cancer Registry, this study looked at 2,629 adults diagnosed with pleural mesothelioma from 2018 to 2022 to see how the COVID-19 pandemic affected diagnoses, treatment and survival. It did not study asbestos exposure. New cases per 100,000 inhabitants were 3.21, 3.11, 2.70, 3.11 and 3.02 in those years. That was a 13.2% fall in 2020, then a 15.2% rise in 2021. In 2020, 58.8% of patients received best supportive care as their primary treatment, the highest share of any year. Chemotherapy use fell from 39.4% of patients in 2019 to 32.0%. After immunotherapy was approved, it was given to 14.5% of patients in 2021 and 31.1% in 2022. Median survival ranged from 8.5 to 10.0 months. Survival did not differ to a statistically significant degree between years, either for all patients or for those given systemic therapy, though the authors saw a mild upward trend in 2021 and 2022. The authors concluded that, following the pandemic's onset, diagnoses and systemic treatment fell abruptly in 2020. They noted the results may not apply to other countries and that some cases may have gone undiagnosed.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective, nationwide observational cohort study using cancer registry data
• Who was studied: 2,629 patients older than 18 diagnosed with pleural mesothelioma in the Netherlands between 2018 and 2022, taken from the Netherlands Cancer Registry. Mesothelioma at non-pleural sites was excluded. Survival was followed to 1 February 2024.
• Exposure: Not asbestos. The study compared patients by year of diagnosis (2018 to 2022) to assess the effect of the COVID-19 pandemic on incidence, treatment and overall survival. No asbestos exposure data were analysed.
• Main results:
  • Pleural mesothelioma incidence per 100,000 inhabitants was 3.21 (2018), 3.11 (2019), 2.70 (2020), 3.11 (2021) and 3.02 (2022).
  • In 2020 the number of newly diagnosed cases per 100,000 people fell by 13.2%.
  • From 2020 to 2021 new diagnoses per 100,000 rose by 15.2%.
  • Across years the patients were predominantly male (82.3% to 87.5%), and median age ranged from 75 to 77 years.
  • Best supportive care was received by the majority of patients and peaked in 2020 at 58.8% of that year's patients.
  • Chemotherapy use fell from 39.4% of patients in 2019 to 32.0% in 2020.
  • After formal approval in the Netherlands, immunotherapy was given to 14.5% of patients in 2021 (and, per Table 1, 165 patients, 31.1%, in 2022).
  • Median overall survival by year of diagnosis was 9.0, 9.0, 8.5, 10.0 and 9.0 months for 2018 to 2022.
  • There was no statistically significant difference in overall survival between patients diagnosed in 2018 to 2022 (p = 0.90).
  • Among patients treated with systemic therapy, overall survival also did not differ significantly by year (p = 0.30). The authors observed a mild, non-significant upward trend in 2021 and 2022.
• The authors' conclusion: The authors concluded that after the onset of the COVID-19 pandemic there was an abrupt decline in incidence and systemic treatment in 2020. This was followed in the next year by an increase in incidence, systemic therapy and (in their wording) overall survival. They also stated that no significant difference in overall survival was observed.
• Limitations the authors state:
  • The findings may not generalize to other countries, because mesothelioma care in the Netherlands is centralized in two expert centers and care is organized differently elsewhere.
  • Some cases may have gone undiagnosed during the pandemic, because access to diagnostic procedures was limited and patients avoided hospitals for fear of infection.
  • Some mesothelioma symptoms may have been mistakenly attributed to COVID-19.
  • The study could not determine whether the decline in systemic therapy led to poorer survival.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Asbestos Exposure, Overall Survival, Cancer Registry, Chemotherapy, Immunotherapy.

Related studies

• Mortality rates from asbestos-related diseases in Italy during the first year of the COVID-19 pandemic — L. Fazzo, E. Grande, et al. (2023)
• Treatment of primary and metastatic peritoneal tumors in the Covid-19 pandemic. Proposals for prioritization from the RENAPE and BIG-RENAPE groups — O. Glehen, V. Kepenekian, et al. (2020)
• County-level longitudinal clustering of COVID-19 mortality to incidence ratio in the United States — N. Vahabi, M. Salehi, et al. (2021)
• The impact of COVID-19 on new mesothelioma diagnoses in Italy — L. Mangone, P. Mancuso, et al. (2022)
• COVID-19 vaccine effectiveness in patients with lung cancer: challenges in the Omicron era — S.M. Hosseini-Moghaddam, S. Swayze, et al. (2026)
• Asbestos Exposure and Severity of COVID-19 — G. Granados, M. Sáez-López, et al. (2022)

Browse more research in Scientific Reports, or return to medical research.