Collateral Damage From COVID-19 Cancer Surgery Delay Revealed

Author: By Lynda Williams, Senior medwireNews Reporter

medwireNews: Researchers have quantified the likely impact of a COVID-19 pandemic-related delay on cancer surgery in England based on life-years gained (LYGs) versus timely surgery as well as the equivalent number associated with COVID-19 hospitalisation. 

“Compared with COVID-19 management, cancer surgery is highly impactful in regard to LYGs per resource expended”, report Clare Turnbull, from the Institute of Cancer Research in London, UK, and co-workers. 

“Delays in diagnosis and surgery cause exponential burden of attributable mortality”, they say in the Annals of Oncology. 

Using data on age-specific, stage-specific cancer survival in England between 2013 and 2017, the researchers calculated that each year, 94,912 major cancer resections result in 80,406 long-term survivors and 1,717,051 LYGs. 

A 3-month delay in cancer surgery was estimated to result in 4755 excess patient deaths and a loss of 92,214 LYGs, and further delay to 6 months would lead to 10,760 attributable deaths and a loss of 208,275 LYGs. 

And while the average LYGs per patient undergoing surgery was 18.1 under standard conditions, a 3- or 6-month delay to cancer surgery reduced the LYGs per patient to 17.1 and 15.9, respectively. 

Surgical delay also had an impact on resource-adjusted life-years gained (RALYGs) when looking at healthcare resource units, where one unit equates to a 12-hour shift of direct nursing or medical care, write Clare Turnbull and co-authors. 

They estimate that cancer surgery achieves on average 2.25 RALYGs normally but after adjusting for a delay of 3 or 6 months, the value fell to 2.12 and 1.97 RALYGs, respectively. 

For comparison, the researchers estimated the effects of community-acquired COVID-19 infection in 683,083 patients, which resulted in 94,912 hospital admissions – equivalent to the annual number for cancer surgery. 

After adjusting for intensive care unit use, these admissions required 1,052,949 healthcare resource units. There were 15,587 deaths but 25,752 attributable lives saved and 482,022 attributable LYGs. Thus, on average, hospitalisation of community-acquired COVID-19 achieved 5.08 LYGs and 0.46 RALYGs per patient. 

“It is therefore noteworthy that a delay of surgery by 6 months results in 208 275 lost life-years for an annual quota of surgical patients: this equates to 43% of the total 482 022 LYGs from hospitalisation of an equivalent number of community-acquired COVID-19 cases”, increasing to 59% after adjusting for differences in resources, the researchers say. 

“Although we have used data for England, cancer survival is broadly similar across most economically developed countries, so the impact of delay per tumour is broadly applicable across Europe” the researchers say. 

“However, variations in incidence of cancer, life expectancy and population age structure mean that predictions regarding total case numbers and LYGs and life-years lost are more difficult to extrapolate, even when scaling for relative size of reference population”, they remark. 

And the authors observe: “Although customised for surgical delay due to the COVID-19 pandemic, this model could readily be adapted to quantify the impact of surgical delay due to other causes.” 

Reference 

Sud A, Jones ME, Broggio J, et al. Collateral damage: the impact on outcomes from cancer surgery of the COVID-19 pandemic. Ann Oncol; Advance online publication 19 May 2020. https://doi.org/10.1016/j.annonc.2020.05.009