COVID-19 Pandemic Cancer Diagnostic Delay Estimated For England

Author: By Lynda Williams, Senior medwireNews Reporter

medwireNews: Two reports published in The Lancet Oncology have used modelling techniques to forecast the impact on patient survival of delays to cancer diagnosis during the COVID-19 pandemic. 

For the first study, Clare Turnbull, from the Institute of Cancer Research in London, UK, and co-workers investigated the effect of COVID-19 lockdown on the 2-week-wait urgent pathway for suspected cancer in England, noting that cancer referrals have decreased by up to 84% during this time. 

Data for 2013–2016 indicate that 6281 patients per month were diagnosed with stage I–III cancer using the 2-week-wait pathway, 27% of whom would be expected to die within 10 years from cancer, the researchers explain. 

They calculated that if 25% of the expected number of patients delayed presentation of symptoms over a 3-month lockdown period, resulting in an average 2-month delay in diagnosis per patient, there would be an additional 181 deaths and 3316 life–years lost. 

If the proportion of patients delaying presentation increased to 50%, the number of additional lives lost would increase to 361 and 6632 life–years would be lost, with corresponding values of 542 additional deaths and 9948 life–years lost if 75% of patients delayed presentation. 

And these losses will increase further should there be a delay in increasing diagnostic capacity in the 3–8 months after lockdown, the team says. 

Noting that a 2-month delay in a 2-week-wait referral was calculated to result in 0.0–0.7 life–years lost per patient, depending on age and diagnosis, Clare Turnbull and team state that “prioritisation and deprioritisation of patients according to tumour referral group and age warrants consideration as a strategy to mitigate the population-level cost of diagnostic delays in terms of lives and life-years lost.”

Ajay Aggarwal, from the London School of Hygiene & Tropical Medicine in the UK, and co-authors of the second study agree that “[u]rgent policy interventions are necessary” to manage the diagnostic delay in cancer patients in England caused by the COVID-19 pandemic.

Their modelling study used data for patients aged 15–84 years old diagnosed with breast (n=32,583), colorectal (n=24,975) and oesophageal cancer (n=6744) in 2010 and followed up until 2014, as well as records for 29,305 lung cancer patients diagnosed in 2012 and followed up until 2015. 

Based on changes to the English National Health Service diagnostic pathway implemented in March 2020, the team created a best-case scenario where patients diagnosed with cancer through screening or routine referral were rerouted to emergency presentation or a 2-week-wait referral route. The mid- and worst-case scenarios then reallocated patients diagnosed through the 2-week-wait referral because this route was operating at 20% of its usual capacity for 3 months or at 20% for 3 months followed by 75% of its usual capacity for a further 3 months, respectively. 

These models estimate a 7.9–9.6% increase in breast cancer deaths up to 5 years from diagnosis, resulting in 281–344 additional deaths, and for patients with colorectal cancer, the increase in deaths within 5 years was 15.3–16.6%, translating into 1445–1563 additional deaths.  

The corresponding values for oesophageal cancer are a 5.8–6.0% increase and 330–342 additional deaths, and for lung cancer a 4.8–5.3% increase and 1235–1372 additional deaths. 

Overall, an estimated 59,204–63,229 life–years would be lost for the four cancer cohorts, Ajay Aggarwal et al summarise. But they emphasise that these figures “do not consider the effect of delay on other cancer types, or the additional effect of changes in treatment pathways for these cancers that are likely to substantially increase the expected avoidable deaths beyond what we have estimated.”

In addition to recommending an increase in routine diagnostic capacity to mitigate the backlog, the team advises the use of “public health messaging that accurately conveys the risk of severe illness from COVID-19 versus the risks of not seeking healthcare advice if patients are symptomatic, and the provision of evidence-based information for clinicians to adequately manage the risks of patients to the risk and benefits of procedures during the pandemic.” 

References 

Sud A, Torr B, Jones ME, et al. Effect of delays in the 2-week-wait cancer referral pathway during the COVID-19 pandemic on cancer survival in the UK: a modelling study. Lancet Oncol; Advance online publication 20 July 2020. https://doi.org/10.1016/S1470-2045(20)30392-2

Maringe C, Spicer J, Morris M, et al. The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population-based, modelling study. Lancet Oncol; Advance online publication 20 July 2020. https://doi.org/10.1016/S1470-2045(20)30388-0