medwireNews: UK researchers have called for urgent action to be taken to avoid unnecessary cancer deaths as a result of delayed surgery due to the COVID-19 pandemic.
Using hazard ratios from observational studies and English cancer survival rates for 2013–2017, Clare Turnbull (Institute of Cancer Research, London) and colleagues estimated that a 3-month delay to surgery across all stage 1–3 cancers would cause 4755 attributable deaths among the 94,912 patients undergoing resections for major cancers per year.
These surgeries would normally result in 80,406 long-term survivors (≥5 years) and 1,717,051 life–years gained (LYG), or 18.1 LYG per patient, but according to their model, a 3-month surgical delay leads to a loss of 92,214 life–years and reduces the number of LYG to 17.1 per patient, the researchers report in the Annals of Oncology.
They estimate that extending the surgical delay to 6 months increases the number of attributable deaths to 10,760 and the number of life–years lost to 208,275, and decreases the number of LYG to 15.9.
When the team looked at individual cancers at specific stages, they found that surgical delays have the greatest impact on individuals with aggressive cancers. For example, a 3-month delay in surgery for stage 2 or 3 bladder, lung, esophageal, ovarian, liver, pancreatic, or stomach cancers results in more than a 17% reduction in survival, which increases to more than 30% with a 6-month delay.
By contrast, cancers with generally good survival prognosis, such as stage 1 hormone-receptor positive breast cancers, were minimally impacted by surgical delays.
Moreover, in older patients (aged >70 years) with early stage colorectal, kidney, and estrogen receptor-positive breast cancers, COVID-19-related mortality had a greater impact on survival than a 3- or 6-month delay to cancer surgery.
To put their findings into context, Turnbull and co-investigators compared the impact of cancer surgery delay with hospital care for patients with community-acquired COVID-19 infection using data for resource-adjusted life-years gained (RALYG).
They estimated that, under standard conditions, cancer surgery affords an average 2.25 RALYGs per patient, which falls to 2.12 with 3 months’ delay and 1.97 with 6 months’ delay. By contrast, hospitalization of an equivalent number of community-acquired COVID-19 patients yields an average of 0.46 RALYG per patient.
Turnbull et al accept that their modelling approach “simplifies the complexity of cancer progression and is solely survival focused.”
But the authors stress that “to avoid knock-on delays, immediate diversion of supra-normal resource volumes are required to process the backlog of cases that will have accrued in the initial months of the pandemic, in which referrals, investigations and surgeries have been reduced by up to 80%.”
They add: “In the medium-to-long term (over the next 3–24 months), avoidance of delay in cancer surgery should be of the highest priority: urgent attention is required to ensure sufficient resourcing for standard capacity of all pathway elements in primary care, cancer diagnostic[s] and [surgery].”
medwireNews is an independent medical news service provided by Springer Healthcare. © 2020 Springer Healthcare part of the Springer Nature Group
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