During the COVID-19 lockdown, two-week-wait (2WW) referrals for suspected cancer in England have reportedly decreased by up to 84%.
A modelling study, published in the Lancet Oncology, used data from Public Health England (PHE) to estimate 10-year cancer survival for 20 common tumour types diagnosed in 2008-2017 at age 30 years and older. Data for diagnoses via the 2WW pathway in 2013-2016 were acquired from the Cancer Waiting Times system.
Three scenarios were examined - a three-month lockdown during which 25%, 50%, and 75% of normal monthly presentations of symptomatic patients were delayed.
Across England in 2013-2016, an average of 6281 patients with stage I-III cancer were diagnosed via the 2WW pathway per month, of whom 1691 (27%) would be predicted to die within 10 years from their disease.
Delays in presentation (with an average delay of two months per patient) would result in 181 additional lives and 3316 life-years lost with a backlog of referrals of 25%. This would increase to 361 additional lives and 6632 life-years lost for a 50% backlog, and 542 additional lives and 9948 life-years lost for a 75% backlog.
Compared with diagnostics being done during the first month after lockdown, additional capacity across months 1-3 would result in 90 additional lives and 1662 live-years lost due to diagnostic delays for the 25% backlog scenario, rising to 183 additional lives and 3362 life-years lost under the 50% scenario, and 276 additional lives and 5075 life-years lost under the 75% scenario.
A delay in providing additional diagnostic capacity until months 3-8 after lockdown would result in 401, 811, and 1231 additional lives, respectively, while the number of life-years lost would be 7332, 14,873, and 22,635, respectively.
A two-month delay in 2WW referrals results in an estimated loss of between 0.0 and 0.7 life-years per referred patient, depending on age and tumour type.
The authors say prompt provision of additional capacity is needed to address the backlog of diagnostics. They suggest prioritisation of patient groups for whom delay would result in most life-years lost warrants consideration as an option for mitigating the aggregate burden of mortality in patients with cancer.
