COVID-19 PANDEMIC: Delays in cancer surgery due to the pandemic are likely to result in thousands of avoidable deaths. Rebooting cancer diagnostic and treatment pathways must now be a priority for healthcare providers
Delays in cancer surgery due to the pandemic are likely to result in thousands of avoidable deaths. Rebooting cancer diagnostic and treatment pathways must now be a priority for healthcare providers.
Collateral damage: the impact on outcomes from cancer surgery of the COVID-19 pandemic
• Lockdown and re-deployment due to the COVID-19 pandemic is causing significant disruption to cancer diagnosis and management.
• 3-month delay to surgery across all Stage 1-3 cancers is estimated to cause >4,700 attributable deaths per year in England.
• The impact on life years lost of 3-6 month to surgery for Stage 1-3 disease varies widely between tumour types.
• Strategic prioritisation of patients for diagnostics and surgery has potential to mitigate deaths attributable to delays.
• The resource-adjusted benefit in avoiding delay in cancer management compares favourably to admission for COVID-19 infection.
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.
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.
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 three/six months would cause attributable death of 4,755/10,760 of these individuals with loss of 92,214/208,275 life-years. For cancer surgery, average life-years gained (LYGs) per patient are 18.1 under standard conditions and 17.1/15.9 with a delay of three/six months (an average loss of 0.97/2.19 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 2.12/1.97 RALYGs following delay of three/six months. For 94,912 hospital COVID-19 admissions, there are 482,022 LYGs requiring of 1,052,949 HCRUs. Hospitalisation of community-acquired COVID-19 patients yields on average per patient 5.08 LYG and 0.46 RALYGs.
Modest delays in surgery for cancer incur significant impact on survival. Delay of three/six months in surgery for incident cancers would mitigate 19%/43% of life-years gained by hospitalisation of an equivalent volume of admissions for community-acquired COVID-19. This rises to 26%/59% 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.