Collateral damage: the impact on outcomes from cancer surgery of the COVID-19 pandemic.
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Authors
Sud, A
Jones, ME
Broggio, J
Loveday, C
Torr, B
Garrett, A
Nicol, DL
Jhanji, S
Boyce, SA
Gronthoud, F
Ward, P
Handy, JM
Yousaf, N
Larkin, J
Suh, Y-E
Scott, S
Pharoah, PDP
Swanton, C
Abbosh, C
Williams, M
Lyratzopoulos, G
Houlston, R
Turnbull, C
Jones, ME
Broggio, J
Loveday, C
Torr, B
Garrett, A
Nicol, DL
Jhanji, S
Boyce, SA
Gronthoud, F
Ward, P
Handy, JM
Yousaf, N
Larkin, J
Suh, Y-E
Scott, S
Pharoah, PDP
Swanton, C
Abbosh, C
Williams, M
Lyratzopoulos, G
Houlston, R
Turnbull, C
Document Type
Journal Article
Date
2020-08-01
Date Accepted
2020-05-10
Abstract
BACKGROUND: Cancer diagnostics and surgery have been disrupted by the response of health care services to the coronavirus disease 2019 (COVID-19) pandemic. Progression of cancers during delay will impact on patients' long-term survival. PATIENTS AND METHODS: 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 3 and 6 months and periods of disruption of 1 and 2 years. Using health care resource costing, we contextualise attributable lives saved and life-years gained (LYGs) from cancer surgery to equivalent volumes of COVID-19 hospitalisations. RESULTS: Per year, 94 912 resections for major cancers result in 80 406 long-term survivors and 1 717 051 LYGs. Per-patient delay of 3/6 months would cause attributable death of 4755/10 760 of these individuals with loss of 92 214/208 275 life-years, respectively. For cancer surgery, average LYGs per patient are 18.1 under standard conditions and 17.1/15.9 with a delay of 3/6 months (an average loss of 0.97/2.19 LYGs per patient), respectively. Taking into account health care resource units (HCRUs), 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 3/6 months. For 94 912 hospital COVID-19 admissions, there are 482 022 LYGs requiring 1 052 949 HCRUs. Hospitalisation of community-acquired COVID-19 patients yields on average per patient 5.08 LYG and 0.46 RALYGs. CONCLUSIONS: Modest delays in surgery for cancer incur significant impact on survival. Delay of 3/6 months in surgery for incident cancers would mitigate 19%/43% of LYGs, respectively, by hospitalisation of an equivalent volume of admissions for community-acquired COVID-19. This rises to 26%/59%, respectively, when considering RALYGs. 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.
Citation
Annals of oncology : official journal of the European Society for Medical Oncology, 2020, 31 (8), pp. 1065 - 1074
Source Title
Publisher
ELSEVIER
ISSN
0923-7534
eISSN
1569-8041
Research Team
Melanoma and Kidney Cancer
Aetiological Epidemiology
Cancer Genomics
Aetiological Epidemiology
Cancer Genomics