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31-07-2020 | COVID-19 | Highlight | News

Cancer diagnostic delays due to COVID-19 may lead to high excess mortality

Laura Cowen

medwireNews: Two modelling studies published in The Lancet Oncology show the impact cancer diagnostic delays due to COVID-19 could have in England, with some scenarios suggesting over a 1000 people could die unnecessarily.

Commenting on the findings, William Hamilton, from the University of Exeter in the UK, says that the assumptions made in each study have their limitations but suggests: “Perhaps a precise figure is not needed—the loss of life is big, whatever the method used. What is most important is the recovery plan.”

The analysis by Clare Turnbull (Institute of Cancer Research, London, UK) and colleagues incorporated observational data on treatment delays for the 20 most common tumor types diagnosed in England between 2008 and 2017 to assess lockdown scenarios in which 25%, 50%, or 75% of the normal monthly volumes of symptomatic patients delayed their presentation until after lockdown.

They report that, with an average presentational delay of 2 months per patient via the 2-week-wait pathway over a 3-month lockdown period, a 25% reduction in referrals could lead to 181 additional lives lost and 3316 additional life–years lost.

Increasing the referral backlog level to 50% resulted in an estimated 361 additional lives lost and 6632 life–years lost, while at a backlog level of 75% there could be 542 additional lives lost and 9948 life–years lost.

Provision of additional diagnostic capacity in months 1 to 3 post-lockdown increased these estimates by a further 50%,but delaying additional diagnostic capacity with provision spread across months 3 to 8 post-lockdown would result in a more than 200% increase in additional lives lost and additional life–years lost.

In this latter scenario, a 25% backlog would result in a further 401 additional lives and 7332 life–years lost due to diagnostic delays, increasing to 811 and 14,873, respectively, with a backlog of 50%, and 1231 and 22,635, respectively, under a 75% backlog.

Turnbull and co-investigators also note that their estimates varied widely by tumor type with attributable lives lost highest for colorectal cancer and attributable life–years lost highest for breast cancer. By contrast, the effect of delays in prostate cancer pathways was estimated to be low, which the researchers say is “predominantly due to the high proportion of indolent cases inherent to the model.”

Taking a more focused approach, Ajay Aggarwal (London School of Hygiene and Tropical Medicine, UK) and colleagues estimated the impact of delays in diagnosis of breast, colorectal, lung, and esophageal cancers over a 12-month period from the initiation of physical distancing measures using English National Health Service cancer registration and hospital administrative data.

They also considered three different scenarios – representing best to worst case according to different 2-week wait and emergency presentation capacities – and calculated that there could be a 15.3–16.6% increase in the number of deaths due to colorectal cancer up to year 5 after diagnosis compared with the pre-pandemic period, corresponding to between 1445 and 1563 additional deaths.

For breast cancer, the increase was 7.9–9.6% (281–344 additional deaths), for esophageal cancer the increase was estimated at 5.8–6.0% (330–342 additional deaths), and for lung cancer it was a 4.8–5.3% increase (1235–1372 additional deaths) up to 5 years after diagnosis.

Overall, this equated to an additional 59,204–63,229 life–years lost across the four cancers compared with pre-pandemic data.

Both study groups conclude that there is an urgent need for interventions to provide additional testing capacity and manage the backlog of patients awaiting cancer diagnostic services.

Aggarwal et al say: “Urgent policy interventions are necessary, particularly the need to manage the backlog within routine diagnostic services to mitigate the expected impact of the COVID-19 pandemic on patients with cancer.

Turnbull and co-authors suggest: “Prioritisation of patient groups for whom delay would result in most life-years lost warrants consideration as an option for mitigating the aggregate burden of mortality in patients with cancer.”

Reflecting on the findings, Hamilton says: “One long-term legacy of the COVID-19 pandemic in the UK might be increased capacity in diagnostic services, but the cost has been considerable.”

medwireNews is an independent medical news service provided by Springer Healthcare. © 2020 Springer Healthcare part of the Springer Nature Group

31 July 2020: The coronavirus pandemic is affecting all healthcare professionals across the globe. Medicine Matters’ focus, in this difficult time, is the dissemination of the latest data to support you in your research and clinical practice, based on the scientific literature. We will update the information we provide on the site, as the data are published. However, please refer to your own professional and governmental guidelines for the latest guidance in your own country.

Lancet Oncol 2020; doi:10.1016/S1470-2045(20)30392-2
Lancet Oncol 2020; doi:10.1016/S1470-2045(20)30388-0
Lancet Oncol 2020; doi:10.1016/S1470-2045(20)30391-0

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