Delays to cancer surgery and other treatment caused by the Covid-19 crisis could result in thousands of additional deaths linked to the pandemic in England, a major new study reports.
New modelling has revealed the extent of the impact that disruption to the cancer care and diagnosis pathway could have on the survival of cancer patients.
Many cancer patients may end up experiencing delays of several months to their cancer treatment in the context of the pandemic - including in operations to remove tumours. Those patients whose cancer will have progressed during the delay and who might otherwise have been effectively cured by surgery could now be at risk of their cancer coming back and shortening their lives.
Scientists at The Institute of Cancer Research, London, analysed existing Public Health England data on delays to cancer surgery on patients' five-year survival rates to estimate the effect of three-month or six-month delays, respectively.
Their modelling, which factored in the risk of hospital-acquired Covid-19-infection, showed dramatic differences in the impact of delay on cancer survival depending on patients' age, their cancer type and whether it was earlier- or later-stage cancer.
The team found that a delay of three months across all 94,912 patients who would have had surgery to remove their cancer over the course of a year would lead to an additional 4,755 deaths. Taking into account the length of time that patients are expected to live after their surgery, the delay would amount to 92,214 years of life lost.
They estimated that surgery for cancer affords on average 18.1 life years per patient, of which on average 1.0 years are lost for a three-month delay or 2.2 years are lost with a six-month delay. Considering healthcare resource more broadly, they compared this with hospital treatment for Covid-19, from which on average 5.1 life years were currently gained per patient.
The new study was published in Annals of Oncology today (Wednesday), and was funded by The Institute of Cancer Research (ICR) itself, with support from Cancer Research UK.
Study leader Professor Clare Turnbull, Professor of Cancer Genomics at The Institute of Cancer Research, London, said:
"The Covid-19 crisis has put enormous pressure on the NHS at every stage of the cancer pathway, from diagnosis right across to surgery and other forms of treatment. Our study shows the impact that delay to cancer treatment will have on patients, with England, and the UK more widely, potentially set for many thousands of attributable cancer deaths as a result of the pandemic.
"Our findings should help policymakers and clinicians make evidence-based decisions as we continue deal with the effects of the pandemic on other areas of medicine. We have to ensure that both patients with Covid-19 and also those with cancer get the best possible care. That means finding ways for the NHS to get back to normal service on cancer diagnostics and surgery as soon as possible, prioritising certain cancer types in particular."
Professor Paul Workman, Chief Executive of The Institute of Cancer Research, London, said:
"The Covid-19 pandemic has already devastated the lives of many people directly. Now, these new findings show the potential for the pandemic to also have a terrible indirect impact on the lives of cancer patients.
"It's positive that the NHS is now beginning to adapt to the new normal, and to think about how cancer services such as surgery can be restored as soon as possible. I also strongly welcome moves to treat patients with targeted cancer drugs, or shorter, more intense courses of radiotherapy, as ways of preserving survival rates while minimising the time they have to spend in hospital."
Notes to editors
"Collateral damage: the impact on outcomes from cancer surgery of the COVID-19 pandemic", by Amit Sud et al. Annals of Oncology. doi: https://doi.org/10.1016/j.annonc.2020.05.009
After online publication, you can provide the following link to the full paper in your published story: https://www.annalsofoncology.org/article/S0923-7534(20)39825-2/fulltext
The new modelling was based on data for England, but the researchers believe that because cancer survival is broadly similar across most economically developed countries, their estimates on the impact of delays to cancer surgery apply across the UK and more widely. Variation across countries in the number of cases for different cancer types and population structure make it harder to extrapolate the findings on total case numbers and years of life gained and lost.
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Annals of Oncology