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

Abstract

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 six months would cause attributable death of 10,555 of these individuals with loss of 205,024 life years. For cancer surgery, average life years gained (LYGs) per patient are 18·1 under standard conditions and 15·9 with a delay of six months (a loss of 2·3 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 1·98 RALYGs following delay of six months. For 94,912 hospital COVID-19 admissions, there are 474,505 LYGs requiring of 1,097,937 HCRUs. Hospitalisation of community-acquired COVID-19 patients yields on average per patient 5·0 LYG and 0·43 RALYGs. Interpretation: Delay of six months in surgery for incident cancers would mitigate 43% of life years gained by hospitalisation of an equivalent volume of admissions for community acquired COVID-19. This rises to 62% 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.

Impact of the COVID‐19 pandemic during Spain's state of emergency on the diagnosis of colorectal cancer

“…This is because a delay in diagnosis and treatment leads to the up‐staging of CRC in many patients. A recent analysis compared the impact of cancer surgery delay with the benefit of hospitalization for COVID‐19 infection, finding that a delay of 6 months in surgery for incident cancers would mitigate 43% of life‐years gained by the hospitalization of an equivalent volume of admissions for community‐acquired COVID‐19 14 . In this situation, it is essential that health systems maintain cancer diagnostic and treatment pathways to avoid a downstream public health crisis of avoidable cancer deaths, keeping in mind the backlog that has already accrued.…”

A cohort study of 30 day mortality after NON-EMERGENCY surgery in a COVID-19 cold site

“…In urological surgery, non-urgent and non-cancer surgery stopped after inception of the regional network. Patients were prioritised, influenced by national guidelines, on basis of their individual cancer risk and potential benefit of having surgery [ 3 , 16 ] judged against patient risk for serious complications of COVID-19 [ 17 ]. In thoracic surgery, due to the urgent nature of the surgery, elective cancer and urgent surgery continued unabated.…”

“…This will have a profoundly detrimental long-term effect on patients and healthcare systems. Patients’ quality of life and survival can be reduced by delayed surgery and there are significant health economic consequences to the population [ [3] , [4] , [5] , [6] ].…”

Changing patterns of mortality during the COVID-19 pandemic: Population-based modelling to understand palliative care implications

“…The characteristics of the additional deaths population is likely to change as the pandemic progresses, and deferred harm from missed routine check-ups or screening becomes more likely. 27 At a population level, we estimate that 22% of COVID-19 deaths occur among people who might have been in their last year of life in the absence of the pandemic, and that among those aged > 85 years, 33% might be in their last year of life. For those with advanced conditions living at home and in care homes, guidelines recommend that general practitioners (GPs), community healthcare staff and community geriatricians urgently review advance care plans with patients and their families and discuss their care preferences in the case of contracting COVID-19.…”