Delayed cancer treatment may increase mortality in the face of COVID-19 | Health

Delayed cancer treatment may increase mortality in the face of COVID-19 | Health
Delayed cancer treatment may increase mortality in the face of COVID-19 | Health

Delayed cancer care may increase mortality amid COVID-19

A pair of studies today estimated the potential effects of the COVID-19 pandemic on cancer deaths, with one predicting an increase in US cancer deaths over the next decade due to screening deficits, and the other suggesting  Given that delaying cancer surgery in Ontario could worsen survival rates.

To accommodate the increase of critically ill COVID-19 patients, many health facilities around the world canceled or delayed appointments for other indications, including cancer.  Before COVID-19 vaccines were available, even patients with non-emergency conditions were advised to stay at home rather than risk infection in crowded hospitals or clinics.

The unintended consequences of these public health measures are still being measured.

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Average 18% drop in colorectal cancer screening

In the first study published in Cancer, a team led by Northwestern University researchers conducted a national quality-of-improvement (QI) study on the return of cancer screening among 748 accredited US cancer programs from April to June 2021.  He used the monthly pandemic and pandemic.  Identification of Screening Test Volume (MTV) for Screening Intervals.

Colorectal cancer (104 out of 129 [80.6%]), cervical cancer (20/29 [69.0%]), breast cancer (241/436 [55.3%]), and lung cancer (98/220 [44.6%]). 

The mean relative changes in MTV were -17.7% for colorectal cancer, -6.8% for cervical cancer, -1.6% for breast cancer and 1.2% for lung cancer.  No geographical difference was observed.

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These findings prompted participating cancer programs to initiate 814 QI projects to break down barriers to cancer screening, including screening resources.  While the impacts of these projects on screening rates by 2021 are still being evaluated, the estimated number of potential MTVs, should all facilities reach their targets, is 57,141 for breast cancer, 6,079 for colorectal cancer, and cervical cancer.  can be 4,280 and 1,744 for .  for lung cancer.

"Cancer screening still needs urgent attention, and screening resources made available online could help close missed critical gaps and address screening in 2020," the researchers wrote.

In a press release from Wiley, the journal's publisher, corresponding author Heidi Nelson, MD, of the American College of Surgeons, said the team hopes the QI program will prevent many cancer deaths.

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"From a standpoint of what this means about our programs, we now know that we can turn to our accredited programs in times of crisis to help address cancer problems at large,"  he said.  “Knowing how excited these accredited programs are to work collaboratively on national-level problems, we expect to release one or two quality improvement projects each year.”

10-year survival may drop to 0.9%

To assess the impact of delaying COVID-19-related cancer surgery on survival, University of Toronto researchers created a microsimulation model using real-world population data on cancer care in Ontario from 2019 and 2020.

The study, published in the Canadian Medical Association Journal (CMAJ), estimated cancer surgery waits in the first 6 months of the pandemic by simulating a slowdown in operating room capacity (60% operating room resources in month 2, 70% in month 2).  , and 85% in 3 to 6 months, compared to simulated epidemic conditions with 100% of resources.

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The model population included 22,799 patients awaiting cancer surgery before the pandemic and 20,177 new referrals.  The median waiting time for surgery was 25 days, compared to 32 days before the pandemic.  As a result, 0.01 to 0.07 life-years were lost per patient across different cancer types, meaning 843 life-years were lost among cancer patients.

The greatest percentage of life-years lost were in patients with non-prostate genitourinary (0.07 life-years lost), gastrointestinal (0.05), and head and neck cancer (0.05), all of which have a high risk of death  .  Ten-year survival fell from 0.3% to 0.9% across all studied cancer types in the epidemic model, with the greatest change in patients with hepatobiliary cancer (26.0% versus 25.1% later).

In the scenario of a 60% reduction in surgical resources for cancer patients in the first 6 months of the pandemic, an incremental increase in pre-epidemic waiting time to 10 to 21 days of waiting time, a loss and reduction of 0.1 to 0.11 life-years per patient  10-year survival of 0.3 to 1.6 percentage points across cancer types.  The changes indicate a loss of 1,539 life-years.

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In a different scenario in which surgical resources were reduced by 60% for the first 2 months of the pandemic and increased by 75% for the next 4 months, the waiting time was shorter than in the first scenario (incremental increase,  8 to 19 days), leading to the loss of fewer (1,306) life-years.

The study's authors call for future studies to characterize the additional impact of epidemic-related clinical delays and changes in cancer stage on cancer survival.

"The epidemic-related slowdown of cancer surgery was predicted to decrease long-term survival for many cancer patients," they wrote.  "Measures to preserve surgical resources and health care capacity for affected patients are critical to minimizing unintended consequences."

Source: CIDRAP, Direct News 99