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How Did the COVID-19 Pandemic Affect Initiation of Cancer Treatment in England?


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In a retrospective analysis reported in The Lancet Oncology, Clark et al found that new prescriptions for systemic anticancer treatment in England initially declined significantly after societal lockdown in response to the COVID-19 pandemic. However, they then increased to higher than prepandemic levels, concurrent with the adoption of treatment options intended to reduce patient risk.

The study used data from a central National Health Service England website database that clinicians must use to register the intention to start all new approved systemic anticancer treatments. The monthly numbers of treatment registrations were calculated for April 2020 after initiation of lockdown on March 23, and for May and June after implementation of treatment options to reduce patient risk, including the use of oral or less immunosuppressive drugs.

The monthly totals were compared with the mean monthly number of registrations and standard deviation (SD) during the control period of September 2019 to February 2020. The absolute difference between each month and the monthly mean during the control period was calculated as the difference in standard deviations from the monthly mean.

"After the onset of the COVID-19 pandemic, there was a reduction in systemic anticancer treatment initiation in England. However, following introduction of treatment options to reduce patient risk, registrations began to increase in May 2020, and reached higher numbers than the prepandemic mean in June 2020, when other clinical and societal risk mitigation factors … are likely to have contributed."
— Clark et al

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Key Findings

The mean number of monthly registrations during the control period was 4,386 (SD = 335), with a range of 3,922 to 4,819. A total of 2,969 registrations were recorded in April 2020, a reduction of 1,417 vs the control period monthly mean (32% reduction, absolute difference = 4.2 SDs, P < .0001).

Total registrations increased to 3,950 in May, a reduction of 436 vs the control period (10% reduction, absolute difference = 1.3 SDs, P < .0001).  Total registrations further increased to 5,022 in June, an increase of 638 vs the control period (15% increase, absolute difference = 1.9 SDs, P < .0001).

In April, the number of registrations decreased by 33% for breast cancer, 57% for prostate cancer, 36% for lung cancer, and 32% for skin cancers. In June, the number of registrations returned to typical levels for breast and skin cancers and were significantly higher for prostate and lung cancers (P < .0001), with relative increases of 83% and 22%, respectively.

The investigators concluded, “After the onset of the COVID-19 pandemic, there was a reduction in systemic anticancer treatment initiation in England. However, following introduction of treatment options to reduce patient risk, registrations began to increase in May 2020, and reached higher numbers than the prepandemic mean in June 2020, when other clinical and societal risk mitigation factors (such as telephone consultations, facemasks, and physical distancing) are likely to have contributed. However, outcomes of providing less treatment or delaying treatment initiation, particularly for advanced cancers and neoadjuvant therapies, require continued assessment.”

James J. Clark, MB BChir, of Imperial College London, Hammersmith Hospital, London, is the corresponding author for The Lancet Oncology article.

Disclosure: For full disclosures of the study authors, visit thelancet.com.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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