Not Just Cancer Care, Even Diagnoses Delayed By COVID-19 Pandemic: UK Study
The study highlights the need for urgent policy interventions to deal with the backlog of patients awaiting routine diagnostic services and to reduce the cancer death toll attributable to the COVID-19 pandemic.
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The authors call for policy makers to focus on three key areas: providing public health messaging that puts the risk of severe illness from COVID-19 into perspective compared with not seeking health-care advice for symptoms of cancer; providing evidence-based information to help health-care workers manage the risks for patients with suspected cancer; and increasing both routine and urgent diagnostic capacity through increased working hours and referrals to any NHS hospital.
“Our findings demonstrate the impact of the national COVID-19 response, which may cut short the lives of thousands of people with cancer in England over the next 5 years”, says Dr Ajay Aggarwal from the London School of Hygiene & Tropical Medicine in the UK who led the research. “Whilst currently attention is being focused on diagnostic pathways where cancer is suspected, the issue is that a significant number of cancers are diagnosed in patients awaiting investigation for symptoms not considered related to be cancer. Therefore we need a whole system approach to avoid the predicted excess deaths.”
During the UK-wide lockdown to combat the COVID-19 pandemic, cancer screening and routine outpatient referral pathways (through which 30-40% of patients are diagnosed) were suspended. The only route to diagnosis for suspected cancer cases was via an urgent 2-week general practitioner (GP) referral or presenting to an emergency department. Since physical distancing measures were introduced on March 16, 2020, urgent referrals have fallen by as much as 80%. With some form of physical distancing expected to continue for up to a year, further negative impact on the lives of cancer patients is likely.
In this study, researchers analysed existing English National Health Service (NHS) cancer registration and hospital administrative data on more than 93,000 cancer patients (aged 15-84 years) diagnosed in 2010-2012, to estimate the effect of delays in diagnosis on cancer survival for four main cancer types—breast, colorectal, oesophageal, and lung. They modelled the impact of reallocating patients from usual screening and non-urgent routine referral pathways (ie, GPs and secondary care) to urgent and emergency pathways (which are associated with more advanced stage of disease at diagnosis), for a year after physical distancing measures were introduced on March 16, 2020, to reflect the expected duration of disruption to diagnostic services.
The authors considered three reallocation scenarios which reflect what is being seen in the NHS during the COVID-19 crisis, providing best and worst case estimates—to calculate the impact on net survival, additional deaths, and years of life lost (the number of years of life a person would have been expected to live had they not died of cancer) compared to pre-pandemic figures.
On average, for each avoidable cancer death due to diagnostic delay, 20 years of life will be lost”, says co-author Professor Richard Sullivan from King’s College London, UK. “These estimates paint a sobering picture and reflect the many young people who are affected by cancer in the prime of life during their most productive years.” The frontline of the cancer diagnostic system is GPs surgeries, and even as lockdown measures are being relaxed, presentation to primary care continues to be much lower than pre-pandemic levels.