Studies highlight potential harms from lockdown-related delays

There is growing evidence that the Covid-19 pandemic is leading to significant delays in the diagnosis of cancer across the globe, which could result in thousands of potentially avoidable deaths from the disease.

Recently published studies from the United States and the United Kingdom highlight the challenges associated with cancer screening and diagnosis in the time of Covid-19. Suspension of routine screening services have been common as social distancing and lockdowns remain in place in many parts of the world.

Recent guidance from the American Society of Clinical Oncology called for cancer screening that required clinic or center visits, such as mammograms and colonoscopies, to be postponed “for the time being” to “conserve health system resources and reduce patient contact with health screening facilities.”

In a recent study published online in JAMA Network Open, researchers with the medical testing company Quest Diagnostics examined weekly changes in the number of patients with newly diagnosed cancers before and during the Covid-19 pandemic, finding a 46% weekly drop in diagnosis for 6 common cancers combined, including a close to 52% weekly drop in breast cancer identifications.

The cross-sectional study included patients from across the U.S. screened for breast, colorectal, lung, pancreatic, gastric or esophageal cancers whose screenings were processed by Quest from Jan. 1, 2018 to April 18, 2020. Mean (SD) weekly numbers of newly diagnosed patients were compared between the baseline period (Jan. 6, 2019 to Feb. 29, 2020) and the Covid-19 period (March 1 to April 18, 2020).

Significant declines were seen in all 6 cancer types during the pandemic period studied.

“Our results indicate a significant decline in newly identified patients with 6 common types of cancer, mirroring findings from other countries,” wrote researcher Harvey W. Kaufman, MD, and colleagues from Quest Diagnostics (Secaucus, New Jersey).

A modeling study published in early June ahead of peer review on the server MedRxiv estimated a potential excess in cancer deaths of close to 34,000 at 1 year related to diagnostic and treatment delays associated with Covid-19.

Two modeling studies from the United Kingdom, published in the August issue of Lancet Oncology, provided further estimates of the potential impact Covid-19 on cancer deaths.

Camile Maringe, PhD, of the London School of Hygiene and Tropical Medicine, and colleagues, estimated that delays in cancer diagnosis due to Covid-19 lockdowns will be responsible for up to 3,600 avoidable deaths in the U.K., with more than 63,000 total years of life lost, during the next 5 years.

Using National Health Service (NHS) data on cancer diagnoses and hospital administrative datasets, the researchers’ modeling study considered best- to worst-case scenario changes in the diagnostic pathway related to Covid-19 to estimate the pandemic’s impact on survival at 1, 3, and 5 years following a cancer diagnosis.

Across three different scenarios, compared with pre-pandemic figures, the researchers estimated a 7.9% to 9.6% increase in deaths from breast cancer up to 5 years following diagnosis, corresponding to between 281 (95% CI, 266-295) and 344 (95% CI, 329-358) additional deaths in the U.K.

The modeling study also estimated:

  • A 15.3% to 16.6% increase in colorectal cancer deaths related to Covid-19 related delays in diagnosis, corresponding to 1,445 to 1,534 additional deaths.
  • 4.8% to 5.3% increase in lung cancer deaths, corresponding to 1,235 to 1,372 additional deaths and a 5.8% to 6.0% increase in esophageal cancer deaths, corresponding to 330 to 342 additional deaths.

“We estimated that changes in health-seeking behavior and the availability of and access to essential diagnostic services resulting from national pandemic measures will result in a large number of additional deaths from breast, colorectal, lung and esophageal cancer in the medium (1 year) and longer term (5 years),” the researchers wrote.

“Our study results do not consider the effect of delay on other cancer types, or the additional effect of changes in treatment pathways for these cancers that are likely to substantially increase the expected avoidable deaths beyond what we have estimated.”

Maringe and colleagues wrote that urgent policy initiatives are needed “to mitigate the indirect effects of the Covid-19 pandemic on patients with cancer.”

In a separate study, Amit Sud, PhD, of the Institute of Cancer Research, London, U.K., and colleagues, estimated hazard ratios associated with diagnostic delays for 20 cancers, after categorizing the cancers into high, medium and low 5-year survival groups.

Their modeling also showed an increase in cancer deaths associated with Covid-19 lockdown delays in cancer diagnosis.

In an editorial published in the same issue of Lancet Oncology, Professor William Hamilton, of the University of Exeter Medical School, Exeter, U.K, wrote that national cancer screening in the U.K. “is now in disarray due to the Covid-19 pandemic.”

“Patients whose symptoms are truly indicative of cancer have been disadvantaged, and some thousands will die as a result,” he wrote. “One long-term legacy of the Covid-19 pandemic in the U.K. might be increased capacity in diagnostic services, but the cost has been considerable.”

  1. Delays in cancer diagnosis due to Covid-19 lockdowns were estimated to be responsible for up to 3,600 avoidable deaths in the U.K., with more than 63,000 total years of life lost, during the next 5 years.
  2. A U.S. study found a 46% weekly reduction in the diagnosis of six major cancers during the Covid-19 pandemic, compared to pre-pandemic levels.

Salynn Boyles, Contributing Writer, BreakingMED™

The study by Maringe et al. was funded by the UK Research and Innovation Economic and Social Research Council. No funding source was provided for the study by Sud et al. and the researchers declared no relevant relationships with industry.

The study by Kaufman et al. was funded by Quest Diagnostics. Harvey Kaufman, MD, and the other researchers reported being employees of and owning stock in Quest Diagnostics.

Editorial writer William Hamilton declared no relevant relationships with industry.

 

Cat ID: 151

Topic ID: 88,151,190,926,138,192,927,151,928,925,934