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

A Sud; M E Jones; J Broggio; C Loveday; B Torr; A Garrett; D L Nicol; S Jhanji; S A Boyce; F Gronthoud; P Ward; J M Handy; N Yousaf; J Larkin; Y-E Suh; S Scott; P D P Pharoah; C Swanton; C Abbosh; M Williams; G Lyratzopoulos; R Houlston; C Turnbull

doi:10.1016/j.annonc.2020.05.009

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

Ann Oncol. 2020 Aug;31(8):1065-1074. doi: 10.1016/j.annonc.2020.05.009. Epub 2020 May 19.

Authors

A Sud¹, M E Jones¹, J Broggio², C Loveday¹, B Torr¹, A Garrett¹, D L Nicol³, S Jhanji⁴, S A Boyce⁵, F Gronthoud⁶, P Ward⁷, J M Handy⁷, N Yousaf⁸, J Larkin⁹, Y-E Suh¹⁰, S Scott¹¹, P D P Pharoah¹², C Swanton¹³, C Abbosh¹³, M Williams¹⁴, G Lyratzopoulos¹⁵, R Houlston¹⁶, C Turnbull¹⁷

Affiliations

¹ Division of Genetics and Epidemiology, Institute of Cancer Research, London.
² National Cancer Registration and Analysis Service, Public Health England, Wellington House, London.
³ Urology Unit, Royal Marsden NHS Foundation Trust, London.
⁴ Department of Anaesthesia, Perioperative Medicine and Critical Care, Royal Marsden NHS Foundation Trust, London; Division of Cancer Biology, Institute of Cancer Research, London.
⁵ Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford.
⁶ Department of Microbiology, Royal Marsden NHS Foundation Trust, London.
⁷ Department of Anaesthesia, Perioperative Medicine and Critical Care, Royal Marsden NHS Foundation Trust, London.
⁸ Lung Cancer Unit.
⁹ Skin and Renal Unit, Royal Marsden NHS Foundation Trust, London; Division of Clinical Studies, Institute of Cancer Research, London.
¹⁰ Department of Clinical Oncology, Royal Marsden NHS Foundation Trust, London.
¹¹ RM Partners, West London Cancer Alliance, Royal Marsden NHS Foundation Trust, London.
¹² Department of Public Health and Primary Care, University of Cambridge, Cambridge.
¹³ Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London; Cancer Evolution and Genome Instability Laboratory, University College London Cancer Institute, London.
¹⁴ Department of Clinical Oncology, Imperial College Healthcare NHS Trust, London; Computational Oncology Group, Imperial College London, London.
¹⁵ National Cancer Registration and Analysis Service, Public Health England, Wellington House, London; Epidemiology of Cancer Healthcare and Outcomes (ECHO) Group, University College London, London.
¹⁶ Division of Genetics and Epidemiology, Institute of Cancer Research, London; Department of Clinical Genetics, Royal Marsden NHS Foundation Trust, London, UK.
¹⁷ Division of Genetics and Epidemiology, Institute of Cancer Research, London; National Cancer Registration and Analysis Service, Public Health England, Wellington House, London; Department of Clinical Genetics, Royal Marsden NHS Foundation Trust, London, UK. Electronic address: [email protected].

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.

Keywords: COVID-19; delay; diagnostics; oncology; survival.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Aged, 80 and over
Betacoronavirus*
COVID-19
Coronavirus Infections / diagnosis
Coronavirus Infections / epidemiology*
Coronavirus Infections / therapy
Female
Hospitalization / trends
Humans
Male
Middle Aged
Neoplasms / diagnosis
Neoplasms / epidemiology*
Neoplasms / surgery*
Pandemics / prevention & control*
Pneumonia, Viral / diagnosis
Pneumonia, Viral / epidemiology*
Pneumonia, Viral / therapy
SARS-CoV-2
Time-to-Treatment / trends*
Treatment Outcome

Abstract

Publication types

MeSH terms

Grants and funding