Estimated impact of the COVID-19 pandemic on cancer services and excess 1-year mortality in people with cancer and multimorbidity: near real-time data on cancer care, cancer deaths and a population-based cohort study.
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Date
2020-11-17ICR Author
Author
Lai, AG
Pasea, L
Banerjee, A
Hall, G
Denaxas, S
Chang, WH
Katsoulis, M
Williams, B
Pillay, D
Noursadeghi, M
Linch, D
Hughes, D
Forster, MD
Turnbull, C
Fitzpatrick, NK
Boyd, K
Foster, GR
Enver, T
Nafilyan, V
Humberstone, B
Neal, RD
Cooper, M
Jones, M
Pritchard-Jones, K
Sullivan, R
Davie, C
Lawler, M
Hemingway, H
Type
Journal Article
Metadata
Show full item recordAbstract
OBJECTIVES: To estimate the impact of the COVID-19 pandemic on cancer care services and overall (direct and indirect) excess deaths in people with cancer. METHODS: We employed near real-time weekly data on cancer care to determine the adverse effect of the pandemic on cancer services. We also used these data, together with national death registrations until June 2020 to model deaths, in excess of background (pre-COVID-19) mortality, in people with cancer. Background mortality risks for 24 cancers with and without COVID-19-relevant comorbidities were obtained from population-based primary care cohort (Clinical Practice Research Datalink) on 3 862 012 adults in England. RESULTS: Declines in urgent referrals (median=-70.4%) and chemotherapy attendances (median=-41.5%) to a nadir (lowest point) in the pandemic were observed. By 31 May, these declines have only partially recovered; urgent referrals (median=-44.5%) and chemotherapy attendances (median=-31.2%). There were short-term excess death registrations for cancer (without COVID-19), with peak relative risk (RR) of 1.17 at week ending on 3 April. The peak RR for all-cause deaths was 2.1 from week ending on 17 April. Based on these findings and recent literature, we modelled 40% and 80% of cancer patients being affected by the pandemic in the long-term. At 40% affected, we estimated 1-year total (direct and indirect) excess deaths in people with cancer as between 7165 and 17 910, using RRs of 1.2 and 1.5, respectively, where 78% of excess deaths occured in patients with ≥1 comorbidity. CONCLUSIONS: Dramatic reductions were detected in the demand for, and supply of, cancer services which have not fully recovered with lockdown easing. These may contribute, over a 1-year time horizon, to substantial excess mortality among people with cancer and multimorbidity. It is urgent to understand how the recovery of general practitioner, oncology and other hospital services might best mitigate these long-term excess mortality risks.
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Subject
Humans
Neoplasms
Population Surveillance
Cause of Death
Survival Rate
Models, Statistical
Follow-Up Studies
Time Factors
Adult
Middle Aged
England
Female
Male
Pandemics
Multimorbidity
COVID-19
SARS-CoV-2
Language
eng
License start date
2020-11-17
Citation
BMJ open, 2020, 10 (11), pp. e043828 - ?
Publisher
BMJ PUBLISHING GROUP