Estimated impact of the COVID-19 pandemic on cancer services and excess 1-year mortality in people with cancer and multimorbidity: near real-time data on cancer care, cancer deaths and a population-based cohort study

Abstract

ObjectivesTo estimate the impact of the COVID-19 pandemic on cancer care services and overall (direct and indirect) excess deaths in people with cancer.MethodsWe employed near real-time weekly data on cancer care to determine the adverse effect of the pandemic on cancer services. We also used these data, together with national death registrations until June 2020 to model deaths, in excess of background (pre-COVID-19) mortality, in people with cancer. Background mortality risks for 24 cancers with and without COVID-19-relevant comorbidities were obtained from population-based primary care cohort (Clinical Practice Research Datalink) on 3 862 012 adults in England.ResultsDeclines in urgent referrals (median=−70.4%) and chemotherapy attendances (median=−41.5%) to a nadir (lowest point) in the pandemic were observed. By 31 May, these declines have only partially recovered; urgent referrals (median=−44.5%) and chemotherapy attendances (median=−31.2%). There were short-term excess death registrations for cancer (without COVID-19), with peak relative risk (RR) of 1.17 at week ending on 3 April. The peak RR for all-cause deaths was 2.1 from week ending on 17 April. Based on these findings and recent literature, we modelled 40% and 80% of cancer patients being affected by the pandemic in the long-term. At 40% affected, we estimated 1-year total (direct and indirect) excess deaths in people with cancer as between 7165 and 17 910, using RRs of 1.2 and 1.5, respectively, where 78% of excess deaths occured in patients with ≥1 comorbidity.ConclusionsDramatic reductions were detected in the demand for, and supply of, cancer services which have not fully recovered with lockdown easing. These may contribute, over a 1-year time horizon, to substantial excess mortality among people with cancer and multimorbidity. It is urgent to understand how the recovery of general practitioner, oncology and other hospital services might best mitigate these long-term excess mortality risks.

New cancer cases at the time of SARS-Cov2 pandemic and related public health policies: A persistent and concerning decrease long after the end of the national lockdown

“…Delaying tumor diagnosis might prevent curable tumors to be treated effectively and impair significantly patient clinical outcomes ( 21 ) ( 22 ). Through a statistical model, Lai et al estimated that this insufficient care could lead to an excess of 6,270 and 33,890 deaths at one year in incident cancer English and American patients, respectively ( 23 ). Another model English study evaluated that the 5-year additional cancer-related deaths due to the pandemic would reach 3,500 for 4 main cancer types ( 24 ).…”

Population risk factors for severe disease and mortality in COVID-19: A global systematic review and meta-analysis

“…This has significant downstream effects on wider healthcare capacity, including the delivery of elective surgical care and mental health services [ 15 ]. For example, DATA-CAN estimates that the impact of reducing access to cancer screening, triage, and treatment will result in a further 7,165–17,910 excess deaths amongst the UK population within one year [ 16 ]. It is for this reason that many national strategies have focused, from the outset, on preventing health systems becoming overloaded by clinical demand [ 17 ].…”

Obesity during the COVID-19 pandemic: both cause of high risk and potential effect of lockdown? A population-based electronic health record study

“… 4 Moreover, as countries plan strategies to exit or scale down lockdown, policies to tackle COVID-19 may have unintended consequences on health care and outcomes for non-COVID-19 diseases, which we reported for cancer and cardiovascular diseases (CVDs). 5 , 6 …”