Cancer diagnostic and surgical pathways must be maintained at normal throughput during the COVID-19 pandemic to avoid a downstream public health crisis of avoidable cancer deaths, warns a study in Annals of Oncology.
A per-day hazard ratio of cancer progression was generated and applied to age-specific five-year net survival of cancer patients, with non-haematological malignancies. Data were obtained from Public Health England National Cancer Registration Service between 2013-2017. A per-patient delay of three and six months was modelled, and periods of disruption of one and two years. Life-years gained, and life-years saved from cancer surgery were contextualised to equivalent volumes of COVID-19 hospitalisations.
Per-year, 94,912 resections for major cancers resulted in 80,406 long-term survivors and 1,717,051 life-years gained. Per-patient delay of three/six months would cause attributable death of 4,755/10,760 of these individuals, with loss of 92,214/208,275 life-years.
Average life-years gained after surgery is 18.1 per patient in standard conditions, and 17.1/15.9 with a delay of three/six months. The greatest rates of death arise from even modest delays to surgery in aggressive cancers, with over a 30 per cent reduction in survival at six months, and over 17 per cent reduction at three months.
To defer a public health crisis of avoidable cancer deaths, urgent ringfencing of resources is required.