COMMENTARY

The Invisible Impact of COVID Delays on Cancer Treatment

David J. Kerr, CBE, MD, DSc

Disclosures

December 07, 2020

This transcript has been edited for clarity.

Hello. I'm David Kerr, professor of cancer medicine at University of Oxford.

Today I'd like to talk about the invisible impact of COVID, with a particular focus on my specialty, which, of course, is cancer treatment.

All of us understand that since March, there has been a redistribution or refocusing of clinical medical resources to deal with the pandemic. That has meant that there are barriers to delivering conventional cancer treatment.

Barriers occur at many different parts in the patient journey. Patients are less likely to attend for screening procedures. General practitioners are referring significantly fewer patients to hospitals. There have been delays in surgery because theaters [operating rooms] have been turned over for emergency ventilation units. And it goes on, all the way down the chain of command in terms of delivering cancer care.

One of the data gaps has been improved by a recent publication in The BMJ by a distinguished group of epidemiologists who looked at the impact of delays in initiating cancer treatment on mortality. They performed a meta-analysis to a high standard, as one would expect, and focused on the common solid tumors. Ultimately, they focused their initial search to 34 studies, all published recently in The BMJ.

In essence, they showed that for every month of delay in initiating treatment, this could have a negative impact on mortality.

Just to take one of their conclusions: In the United Kingdom alone, a 12-week surgery delay for all breast cancer patients over a year of lockdown could translate into 1400 additional deaths. This is with surgery alone. This wasn't counting the downstream effects of any delays in radiotherapy or initiation of systemic treatment.

The authors say that these data need to be validated properly and prospectively. In one sense, they argue — and, I think, correctly — that it shows the relative weakness of our current data-gathering and information system, that they have to go back and do a meta-analysis of retrospective studies in order to generate this hypothetical model. It would be better if we were collecting data in real time so that we could monitor prospectively and determine the real impact rather than it being this projected negative impact on mortality through a meta-analysis.

This gives rise to a great cause for concern. With our National Health System (NHS) in the United Kingdom, we're doing our best to maintain services as fully as possible. Our government is advertising that the NHS is open for business and that we want to see and treat as many patients as we can. As I have discussed before on Medscape, in terms of our own practice of medical oncology, we have delivered and adapted a set of guidelines with which we've been able to deliver chemotherapy effectively and safely during this time.

Nevertheless, it serves as a very strong warning shot to governments and healthcare systems around the world that we do need to think through a better means now. And post-pandemic, we need to think about how we're going to deal with the flow of patients coming through for treatment, which is potentially life-threatening. Should we have COVID-free hospitals and units? Rather than abandoning everything and focusing the entire hospital reserve on COVID, how do we achieve a balance? Of course, we must do our best for patients with COVID. But how do we achieve a balance for those less visible patients, our patients with a variety of cancer types?

See what you think about the paper. I'd be interested in any responses or comments you'd like to make.

Thanks again for listening. As always, Medscapers, ahoy.

David J. Kerr, CBE, MD, DSc, is a professor of cancer medicine at the University of Oxford. He is recognized internationally for his work in the research and treatment of colorectal cancer and has founded three university spin-out companies: COBRA Therapeutics, Celleron Therapeutics, and Oxford Cancer Biomarkers. In 2002, he was appointed Commander of the British Empire by Queen Elizabeth II.

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