The impact of national non-pharmaceutical interventions (‘lockdowns’) on the presentation of cancer patients

Abstract

One of the most ignored aspects of the COVID-19 pandemic has been the impact of public health measures by governments on wider health and welfare. From March 2020, hospitals in the UK saw a dramatic reduction in patients with cancer presenting due to multifactorial reasons. The impact of the pandemic on patients with cancer in the South East London Cancer Alliance was studied. The specific aims were (1) to examine the reduction in cancer diagnoses during the first wave of the pandemic and (2) to examine the stage of diagnosis of patients with cancer presenting during the pandemic compared with that of patients presenting before the pandemic.There was an 18.2% reduction in new cancer diagnoses (an estimate of 987 cancers), when compared with 2019. This fall in cancer diagnoses was most marked in patients with prostate (51.4%), gynaecological (29.7%), breast (29.5%) and lung (23.4%) cancers. There was an overall 3.9% increase in advanced stage presentation (Stages 3 and 4), with an overall 6.8% increase in Stage 4 cancers during this period. The greatest shifts were seen in lung (increase of 6.3%, with an 11.2% increase in Stage 4 cancer alone) and colorectal (5.4%) cancers. For prostate cancer, there was an increase in 3.8% in those presenting with Stage 4 disease. For breast cancer, there was an 8% reduction in patients diagnosed with Stage 1 cancer with commensurate increases in the proportion of those with Stage 2 disease.The experiences in cancer are a salient warning that pandemic control measures and policy need to balance all health and welfare. Alternative strategies need to be adopted during further waves of the current and any future pandemic to ensure that patients with cancer are prioritised for diagnosis and treatment to prevent late-stage presentation and an increase in avoidable deaths.

Economic impact of avoidable cancer deaths caused by diagnostic delay during the COVID-19 pandemic: A national population-based modelling study in England, UK

“…It should be noted that our estimates are very conservative with regards to the health and economic impact. Recent data [5] suggest that the drop in expected cancer diagnoses based on yearly estimates is far greater than the estimates we have made in this paper [14]. For example, for bowel cancer between April to October 2020, over 3500 fewer people had been diagnosed and treated for colorectal cancer in England than would have been expected [7].…”

“…In the UK, following the first wave of the pandemic, up to 3 million men and women did not receive screening investigations due to suspension of these services, fewer patients were referred with suspected cancers [1], and 3.2 million fewer investigations (e.g., colonoscopy, cystoscopy, gastroscopy, CT scans, MRI between March and July 2020) were performed due to cancellation or deferral [2,3]. This decrease in referrals and diagnostic investigation implies an eventual later diagnosis with more advanced-stage cancer, which will have a direct impact on long term prognosis [4,5]. As well as diagnostic pathways, it has also become rapidly apparent that treatment delays [6], especially for cancer surgery, were also occurring [7,8].…”

The Impact of COVID-19 on the Delivery of Systemic Anti-Cancer Treatment at Guy’s Cancer Centre

“…In our study, it was noted that there was an increase in the proportion of patients with stage IV disease being treated in 2020 when compared to 2019. We postulate that these numbers reflect the backlog of undiagnosed cancer cases early on in the pandemic in 2020 [ 7 ]. Furthermore, there was a lower proportion of patients receiving chemotherapy in 2020 when compared to 2019.…”

Differences in the Impact of COVID-19 on Pathology Laboratories and Cancer Diagnosis in Girona

“…To the best of our knowledge, the only study to have analyzed cancer data based on pathology results in Spain observed a 17% reduction in diagnoses, this finding being similar to those of other studies [ 15 , 16 ]. These figures reflect the effort to recover care services, especially oncology referrals, despite their saturation after reaching a 70% reduction in activity during the first wave, as other studies have shown [ 17 , 18 , 19 ]. In addition, despite there being less activity in the pathology departments during COVID-19 than during 2019, the probability of neoplasia diagnosis during the pandemic has been statistically significantly higher.…”