Pandemic-Induced Surgery Delays Could Worsen Cancer Survival

By Will Boggs MD

May 28, 2020

NEW YORK (Reuters Health) - Delays in cancer surgery related to the COVID-19 pandemic could substantially worsen survival outcomes, according to a model study.

"Lockdown and redeployment due to the COVID-19 pandemic are causing significant disruption to cancer diagnosis and management," Dr. Clare Turnbull of the Institute of Cancer Research, in London, told Reuters Health by email. "A 3-month delay to surgery across all Stage 1-3 cancers is estimated to cause >4,700 attributable deaths per year in England."

According to current projections, COVID-19-related disruptions in clinical services could last for 18 months or more.

Dr. Turnbull and colleagues used published data from studies examining the impact on overall survival from delay in cancer surgery to model the impact of cancer surgery delays associated with the pandemic on long-term survival of people with cancer.

Even modest delays to surgery resulted in significantly increased rates of death from aggressive cancers, with more than 30% reduction in survival at six months and more than 17% reduction in survival at three months for patients with stage-2 or -3 cancers of the bladder, lung, esophagus, ovary, liver, pancreas or stomach, the researchers report in Annals of Oncology.

Accounting for the possibility of nosocomial COVID-19 infection, delay of surgery by three months had a minimal impact on survival for cancers with a relatively good overall prognosis (for example, early-stage breast cancer).

Based on an estimated volume of nearly 95,000 annual surgical resections for common invasive adult cancers in England, there would be 4,755 excess deaths with a surgical delay of three months and 10,760 excess deaths with a six-month delay.

Prior to the COVID-19 pandemic, cancer surgery was associated with an average 18.1 life-years gained (LYG) per patient. These gains would be reduced to 17.1 with three months' surgical delay and to 15.9 with six months' delay.

A delay of surgery by six months would result in more than 208,000 lost life-years for an annual quota of surgical patients, which is equivalent to 43% of the total 482,022 life-years gained from hospitalization of an equivalent number of community-acquired COVID-19 cases, according to the model.

"A substantial back-log of cancer cases has already accrued, on account of reluctance of patients to seek healthcare, disruption to primary care, diversion of staff from cancer diagnostics and surgery, and concern about the safety of these procedures," Dr. Turnbull said. "Supranormal capacity will be required to address swiftly the accumulated back-log."

"Failure to ring-fence capacity both for this back-log and for maintaining of rapid pathways for cancer diagnosis and surgery will result in a sizeable delayed public-health crisis of avoidable cancer deaths," she concluded.

SOURCE: Annals of Oncology, online May 19, 2020.