Collateral damage: the impact on outcomes from cancer surgery of the COVID-19 pandemic

• Published in: Annals of oncology Vol. 31; no. 8; pp. 1065 - 1074
• Main Authors: Sud, A., Jones, M.E., Broggio, J., Loveday, C., Torr, B., Garrett, A., Nicol, D.L., Jhanji, S., Boyce, S.A., Gronthoud, F., Ward, P., Handy, J.M., Yousaf, N., Larkin, J., Suh, Y-E., Scott, S., Pharoah, P.D.P., Swanton, C., Abbosh, C., Williams, M., Lyratzopoulos, G., Houlston, R., Turnbull, C.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.08.2020; The Author(s). Published by Elsevier Ltd on behalf of European Society for Medical Oncology
• Subjects: Adult; Aged; Aged, 80 and over; Betacoronavirus; Coronavirus Infections - diagnosis; Coronavirus Infections - epidemiology; Coronavirus Infections - therapy; COVID-19; delay; diagnostics; Female; Hospitalization - trends; Humans; Male; Middle Aged; Neoplasms - diagnosis; Neoplasms - epidemiology; Neoplasms - surgery; oncology; Pandemics - prevention & control; Pneumonia, Viral - diagnosis; Pneumonia, Viral - epidemiology; Pneumonia, Viral - therapy; SARS-CoV-2; survival; Time-to-Treatment - trends; Treatment Outcome; COVID-19; diagnostics; delay; oncology; survival
• ISSN: 0923-7534; 1569-8041; 1569-8041
• DOI: 10.1016/j.annonc.2020.05.009

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. 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. 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. 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. •Lockdown and re-deployment due to the COVID-19 pandemic have caused significant disruption to cancer diagnosis and management.•A 3-month delay to surgery across all stage 1–3 cancers is estimated to cause >4700 attributable deaths per year in England.•The impact on life-years lost of 3–6-month delay 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 with admission for COVID-19 infection.