In a population-based modeling study reported in The Lancet Oncology, Maringe et al estimated that delays in diagnosis due to the COVID-19 pandemic could result in 3,291 to 3,621 additional deaths from breast, colorectal, esophageal, and lung cancers within 5 years.
As stated by the investigators, “Since a national lockdown was introduced across the United Kingdom in March 2020 in response to the COVID-19 pandemic, cancer screening has been suspended, routine diagnostic work deferred, and only urgent symptomatic cases prioritized for diagnostic intervention. In this study, we estimated the impact of delays in diagnosis on cancer survival outcomes in four major tumor types.”
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Study Details
The study used linked English National Health Service (NHS) cancer registration and hospital administrative data sets for patients aged 15 to 84 years diagnosed with breast, colorectal, and esophageal cancers between January 2010 and December 2010 (with follow-up data until December 2014) or diagnosed with lung cancer between January 2012 and December 2012 (with follow-up data until December 2015).
Based on these data, a routes-to-diagnosis framework was used to estimate the impact of delays in diagnosis over a 12-month period from the start of physical distancing measures on March 16, 2020, up to 5 years after diagnosis. Three scenarios involving reallocation of patients who were on screening and routine referral pathways to urgent and emergency pathways were used to represent best- to worst-case scenarios, with these scenarios reflecting actual changes in diagnostic pathways observed in the NHS as of March 16, 2020.
Key Findings
Data were used from 32,583 patients with breast cancer, 24,975 with colorectal cancer, 6,744 with esophageal cancer, and 29,305 with lung cancer.
Compared with prepandemic data, across the three different scenarios, the estimated increases in death from each type of cancer up to year 5 after diagnosis were:
- 7.9% to 9.6% for breast cancer, corresponding to between 281 and 344 additional deaths
- 15.3% to 16.6% for colorectal cancer, corresponding to between 1,445 and 1,563 additional deaths
- 4.8% to 5.3% for lung cancer, corresponding to between 1,235 and 1,372 additional deaths
- 5.8% to 6.0% for esophageal cancer, corresponding to 330 to 342 additional deaths.
For the four tumor types combined, the model estimates correspond to 3,291 to 3,621 additional deaths within 5 years across the three scenarios, with an estimated total additional 59,204 to 63,229 years of life lost.
The investigators concluded, “Substantial increases in the number of avoidable cancer deaths in England are to be expected as a result of diagnostic delays due to the COVID-19 pandemic in the United Kingdom. Urgent policy interventions are necessary, particularly the need to manage the backlog within routine diagnostic services to mitigate the expected impact of the COVID-19 pandemic on patients with cancer.”
Ajay Aggarwal, PhD, of the Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, is the corresponding author for The Lancet Oncology article.
Disclosure: The study was funded by UK Research and Innovation Economic and Social Research Council. For full disclosures of the study authors, visit thelancet.com.
