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      The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population-based, modelling study.

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          Abstract

          Since a national lockdown was introduced across the UK in March, 2020, in response to the COVID-19 pandemic, cancer screening has been suspended, routine diagnostic work deferred, and only urgent symptomatic cases prioritised for diagnostic intervention. In this study, we estimated the impact of delays in diagnosis on cancer survival outcomes in four major tumour types.

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          Collateral damage: the impact on outcomes from cancer surgery of the COVID-19 pandemic

          Amit Sud, Michael E.B. Jones, John Broggio … (2020)
          Background Cancer diagnostics and surgery have been disrupted by the response of healthcare services to the COVID-19 pandemic. Progression of cancers during delay will impact on patient long-term survival. Methods We generated per-day hazard ratios of cancer progression from observational studies and applied these to age-specific, stage-specific cancer survival for England 2013-2017. We modelled per-patient delay of three months and six months and periods of disruption of one year and two years. Using healthcare resource costing, we contextualise attributable lives saved and life-years gained from cancer surgery to equivalent volumes of COVID-19 hospitalisations. Findings Per year, 94,912 resections for major cancers result in 80,406 long-term survivors and 1,717,051 life years gained. Per-patient delay of three/six months would cause attributable death of 4,755/10,760 of these individuals with loss of 92,214/208,275 life-years. For cancer surgery, average life-years gained (LYGs) per patient are 18.1 under standard conditions and 17.1/15.9 with a delay of three/six months (an average loss of 0.97/2.19 LYG per patient). Taking into account units of healthcare resource (HCRU), surgery results on average per patient in 2.25 resource-adjusted life-years gained (RALYGs) under standard conditions and 2.12/1.97 RALYGs following delay of three/six months. For 94,912 hospital COVID-19 admissions, there are 482,022 LYGs requiring of 1,052,949 HCRUs. Hospitalisation of community-acquired COVID-19 patients yields on average per patient 5.08 LYG and 0.46 RALYGs. Interpretation Modest delays in surgery for cancer incur significant impact on survival. Delay of three/six months in surgery for incident cancers would mitigate 19%/43% of life-years gained by hospitalisation of an equivalent volume of admissions for community-acquired COVID-19. This rises to 26%/59% when considering resource-adjusted life-years gained. To avoid a downstream public health crisis of avoidable cancer deaths, cancer diagnostic and surgical pathways must be maintained at normal throughput, with rapid attention to any backlog already accrued.
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            The impact of the COVID-19 pandemic on cancer care

            Mike Richards, Michael Anderson, Paul Carter … (2020)
            The COVID-19 pandemic has disrupted the spectrum of cancer care, including delaying diagnoses and treatment and halting clinical trials. In response, healthcare systems are rapidly reorganizing cancer services to ensure that patients continue to receive essential care while minimizing exposure to SARS-CoV-2 infection.
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              The relative survival rate: a statistical methodology.

              F Ederer, Cathy Cutler, Robert L. Axtell (1961)
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                Author and article information

                Journal
                Journal ID (iso-abbrev): Lancet Oncol
                Title: The Lancet. Oncology
                Publisher: Elsevier BV
                ISSN (Electronic): 1474-5488
                ISSN (Print): 1470-2045
                Publication date (Electronic): Aug 2020
                Volume: 21
                Issue: 8
                Affiliations
                [1 ] Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
                [2 ] School of Cancer and Pharmaceutical Sciences, King's College London, London, UK; Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
                [3 ] Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK.
                [4 ] School of Cancer and Pharmaceutical Sciences, King's College London, London, UK; Institute of Cancer Policy, King's College London, London, UK; Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
                [5 ] Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK; Institute of Cancer Policy, King's College London, London, UK; Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK. Electronic address: ajay.aggarwal@lshtm.ac.uk.
                Article
                Publisher Item ID: S1470-2045(20)30388-0
                DOI: 10.1016/S1470-2045(20)30388-0
                PMC ID: 7417808
                PubMed ID: 32702310
                SO-VID: cdaaf25d-295d-4e85-802c-4b7f5be8045a
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