Delays to cancer diagnosis caused by COVID-19 could be responsible for thousands of avoidable deaths in the UK, a new report study published in The Lancet has found.
In a ground-breaking new population-based modelling study, a London-based research team has attempted to calculate the impact of the coronavirus pandemic on cancer diagnosis and treatment outcomes.
In the paper The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population-based, modelling study researchers used sophisticated methods to estimate the impact of delays in diagnosis on cancer survival outcomes in four common tumour types.
Using English National Health Service (NHS) cancer registration and hospital administrative datasets for patients diagnosed with four tumour types (breast, colorectal, lung and oesophageal cancer) the team developed its own ‘routes-to-diagnosis framework’ to estimate the impact of delayed diagnosis on patient outcomes.
The innovative model enabled academics to estimate the impact on net survival at one, three, and five years after diagnosis to calculate the additional deaths attributable to cancer, and the total years of life lost (YLLs) compared with pre-pandemic data.
The researchers estimate that delays in diagnosis will result in between 281-344 additional breast cancer deaths; 1,445-1,563 colorectal cancer deaths; 1,235-1,372 lung cancer deaths; and 330-342 oesophageal cancer deaths.
The study was published in The Lancet in July 2020 and is the first attempt to quantify the impact of COVID-19 on cancer diagnosis. While cautioning that the results are predictions, they paint a depressing picture of a healthcare system that’s struggling to cope with coronavirus and its impact on cancer patients.
Impact on cancer diagnosis
When discussing the findings, the team describes how cancer diagnostic services were either stopped or operated at a significantly reduced capacity as the health service in the UK focused on tackling the first wave of coronavirus infections. In one example cited in the paper, there was a 90% reduction in the number of endoscopies completed in April 2020, when compared with the previous three months (before lockdown).
As well as reduced diagnostic capacity, GP referrals fell dramatically during lockdown, with patients encouraged to stay at home unless they had ‘urgent concerns’. The strong public messaging in the UK and the widespread adherence to lockdown rules may also have stopped patients with common symptoms of cancer from seeking help, the authors suggest.
In analysing their finding, the researchers conclude that “changes in health-seeking behaviour and the availability of and access to essential diagnostic services resulting from national pandemic measures will result in a large number of additional deaths.”
Lessons for the future
The team is calling for “urgent policy interventions” that could minimise and potentially mitigate against the negative impact of the coronavirus pandemic on those people with cancer.
In the paper, researchers call for a 40% increase in routine diagnostic capacity to tackle the backlog of potential cancer cases. Alongside a greater availability of in-person primary care appointments and a relaxing of lockdown conditions, they are hopeful that more patients will seek help if they recognise likely cancer symptoms.
The team suggests that public health messages should convey the risk of severe illness from COVID-19 against the dangers of not seeking healthcare advice if patients recognise symptoms. GPs and primary healthcare professionals should also be provided with guidance on the risks and benefits of procedures during the pandemic.
While the study focuses solely on the UK National Health Service (NHS), across the world, a late-stage cancer diagnosis could be responsible for millions of preventable cancer deaths. Where there are delays, clinicians and patients should consider alternative tests, such as those offered by RGCC, that specialise in liquid biopsy, to help diagnose and identify cancer.