The COVID-19 emergency could result in at least 20% more deaths over the next 12 months in people who have been newly diagnosed with cancer, according to a study involving Queen’s University Belfast with University College London and DATA-CAN.
DATA-CAN the UK's Health Data Research Hub for Cancer is a UK-wide partnership that aims to unlock the power of health data to improve cancer care. Partners are Queen's University Belfast, University College London Partners (UCLP), University of Leeds, Leeds Teaching Hospitals Trust, Genomics England and IQVIA.
The new analysis is the first to focus on the impact of the emergency on mortality rates in people with cancer and uses data from the health records of over 3.5 million patients.
The study estimates that pre-COVID-19, about 31,354 newly diagnosed cancer patients would die within a year in England. As a result of the emergency, there could be at least 6,270 additional deaths in newly diagnosed cancer patients alone. This number could rise to an estimated 17,915 additional deaths in a year if all people currently living with cancer are considered.
Adding to the relevance of the study for cancer patients, the researchers analysed recent weekly data from major cancer centres in the UK (including all 5 Health and Social Care Trusts in Northern Ireland) and found a 76% average decrease in urgent referrals from GPs for people with suspected cancers and a 60% average decrease in chemotherapy appointments for cancer patients compared to pre-COVID-19 levels.
Speaking about these data, Professor Mark Lawler Associate Pro-Vice-Chancellor and Professor of Digital Health at Queen’s University Belfast, Scientific Lead DATA-CAN and a co-author on the paper said: “Our analysis of these data shows unequivocally that both urgent referral rates (our early warning system or “red flag” for catching cancer at its earliest stage) and patient attendances for chemotherapy delivery (an appropriate proxy measure of a cancer service’s activity) have dropped significantly.”
A collaborator on the project Dr Kathryn Boyd, Medical Director of the Northern Ireland Cancer Network, said: “These data provide clear evidence of the need to adequately resource cancer services during the COVID-19 emergency. Changes to how services are delivered have been made to shield patients from COVID 19 and patients need to come forward for diagnosis and treatment.”
Senior author Professor Harry Hemingway, Director at UCL Institute of Health Informatics, added: “The overall impact of the COVID-19 emergency on deaths in cancer patients could be substantial. There are many factors operating here including changes to diagnosis and treatment protocols, social distancing measures, changes in people’s behaviour in seeking medical attention and the economic impact of COVID-19, as well as deaths due to COVID-19 infection.”
The paper also models publicly available US data and shows an additional 33,890 deaths in the US in newly diagnosed cancer patients over the next year. The study estimates that pre-COVID-19, about 169,433 newly diagnosed cancer patients would die within a year in the US.
Professor Lawler added: “We applied our model to new cancers in the UK and the US, using publicly available data. The results are extremely concerning. We believe countries need to rapidly understand how the emergency is affecting cancer outcomes, otherwise we risk adding cancer and other underlying health conditions to the escalating death toll of the COVID-19 pandemic.”
This research provides a comprehensive picture of how people living with a range of different cancers are affected by other often treatable long-term conditions including cardiovascular disease, hypertension, obesity and diabetes. Nearly eight out of ten of the additional deaths in people with cancer are estimated to occur in people with one or more of these long-term conditions.
Lead author, Dr Alvina Lai (UCL Institute of Health Informatics) said: “Our findings demonstrate the serious potential for unintended consequences of the response to the COVID-19 pandemic, which may negatively impact on patients with cancer and other underlying health conditions. It is vital that these patients are recognised as being vulnerable and that their care is managed appropriately”.
Dr Charlie Davie (DATA-CAN Hub Director), said: “Our study highlights the value of bringing together data from multiple sources to enable researchers, health systems and policy makers to improve cancer management for our patients during this pandemic.”
Pete Wheatstone, a patient and a member of the Public and Patient Involvement and Engagement group of DATA-CAN added: “This research demonstrates the value to cancer patients, the wider public and decision-makers when trusted professionals use our patient data to help decide the best course of action, highlighting the need analyse these data quickly and accurately to inform and influence current events”
The researchers say it is crucial for weekly national data on mortality and cancer services activity to be made available urgently, to enable better understanding of which disease comorbidities pose the greatest risk to life and inform how health services should be prioritised, in order to give patients the best possible care.
Funding for the study was provided from Health Data Research UK (HDRUK), and the National Institute of Health Research (NIHR) University College London Hospitals Biomedical Research Centre.
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