Thousands of lives at risk from pandemic treatment delays

Delays to cancer surgery and other treatment driven by the COVID-19 pandemic could be linked to thousands of additional deaths in England, scientists at the Institute of Cancer Research (ICR) are warning.

Cancer patients could face delays of several months to their treatment in the wake of the pandemic, including in crucial operations to remove tumours. Those whose cancer will have progressed during the delay and who might otherwise have been cured by surgery could now be at risk of their cancer returning and shortening survival.

Scientists at the ICR analysed existing Public Health England data on delays to cancer surgery on patients’ five-year survival rates to estimate the effect of three-month or six-month delays, respectively. Their modelling, which took into account the risk of hospital-acquired COVID-19-infection, showed “dramatic differences in the impact of delay on cancer survival depending on patients’ age, their cancer type and whether it was earlier- or later-stage cancer”, the Institute said.

According to the team’s findings, a delay of three months across all 94,912 patients who would have had surgery to remove their cancer over the course of a year would lead to an extra 4,755 deaths. Accounting for the length of time that patients are expected to live after surgery, the delay would amount to 92,214 years of life lost.

“The COVID-19 crisis has put enormous pressure on the NHS at every stage of the cancer pathway, from diagnosis right across to surgery and other forms of treatment. Our study shows the impact that delay to cancer treatment will have on patients, with England, and the UK more widely, potentially set for many thousands of attributable cancer deaths as a result of the pandemic,” said study leader Professor Clare Turnbull, Professor of Cancer Genomics at The Institute of Cancer Research, London, and consultant clinician at The Royal Marsden NHS Foundation Trust.

“We have to ensure that both patients with COVID-19 and also those with cancer get the best possible care. That means finding ways for the NHS to get back to normal service on cancer diagnostics and surgery as soon as possible, prioritising certain cancer types in particular.”

The study’s findings, published in Annals of Oncology and funded by the ICR with support from Cancer Research UK, came as NHS England and NHS Improvement issued a new roadmap for urgent and planned services, unveiling a series of measures designed to help local hospitals begin to increase routine operations and treatment.
Under the plans, as many outpatient appointments as possible will be conducted remotely, and those who do need a face to face consultation will be asked not to attend if they have COVID symptoms. People requiring a long hospital stay will be ‘continuously monitored for symptoms and retested between five and seven days after admission’, while those due for discharge to a care home will be tested up to 48 hours before they are due to leave.

“Now that we are confident that we have passed the first peak of coronavirus, it is important that we bring back those services where we can, but only where that can be done safely – the virus is still circulating and we don’t want to put our patients, the public or our staff at greater risk,” said NHS national medical director, Professor Stephen Powis.