Estimated impact of the COVID-19 pandemic on cancer services and excess 1-year mortality in people with cancer and multimorbidity: near real-time data on cancer care, cancer deaths and a population-based cohort study
Richard D Neal,
Amitava Banerjee,
Deenan Pillay,
Vahe Nafilyan,
Clare Turnbull,
Harry Hemingway,
Bryan Williams,
Mark Lawler,
Monica Jones,
Kathy Pritchard-Jones,
Mahdad Noursadeghi,
Richard Sullivan,
Graham R Foster,
Ben Humberstone,
Alvina G Lai,
Laura Pasea,
Geoff Hall,
Wai Hoong Chang,
Michail Katsoulis,
David Linch,
Derralynn Hughes,
Martin D Forster,
Natalie K Fitzpatrick,
Kathryn Boyd,
Tariq Enver,
Matt Cooper,
Charlie Davie
Affiliations
Richard D Neal
Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
Amitava Banerjee
professor of clinical data science
Deenan Pillay
Infection and Immunity, University College London, London, UK
Vahe Nafilyan
1 Office for National Statistics, Newport, UK
Clare Turnbull
Institute of Cancer Research Division of Genetics and Epidemiology, Sutton, UK
Harry Hemingway
DRIVE, Great Ormond Street Hospital for Children, London, UK
Bryan Williams
NIHR University College London Hospitals Biomedical Research Centre, London, UK
Mark Lawler
DATA-CAN, Health Data Research UK hub for cancer hosted by UCLPartners, London, UK
Monica Jones
Central Team, Health Data Research UK, London, UK
Kathy Pritchard-Jones
DATA-CAN, Health Data Research UK hub for cancer hosted by UCLPartners, London, UK
Mahdad Noursadeghi
Division of Infection and Immunity, University College London, London, UK
Richard Sullivan
Institute of Cancer Policy & Centre for Conflict & Health Research, King`s College London, London, UK
Graham R Foster
Barts Liver Centre, Blizard Institute, Queen Mary University of London, London, UK
Ben Humberstone
Office for National Statistics, London, UK
Alvina G Lai
associate professor health informatics
Laura Pasea
University College London, London, UK
Geoff Hall
University of Leeds, Leeds, UK
Wai Hoong Chang
Institute of Health Informatics, University College London, London, UK
Michail Katsoulis
Institute of Health Informatics, University College London, London, UK
David Linch
University College London Hospitals NIHR Biomedical Research Centre, London, UK
Derralynn Hughes
Lysosomal Storage Disorder Unit, Royal Free Hospital, London, UK
Martin D Forster
University College London Hospitals NHS Trust, London, UK
Natalie K Fitzpatrick
Institute of Health Informatics, University College London, London, UK
Kathryn Boyd
Northern Ireland Cancer Network, Northern Ireland, UK
Tariq Enver
University College London Cancer Institute, London, UK
Matt Cooper
DATA-CAN, Health Data Research UK hub for cancer hosted by UCLPartners, London, UK
Charlie Davie
DATA-CAN, Health Data Research UK hub for cancer hosted by UCLPartners, London, UK
Objectives To estimate the impact of the COVID-19 pandemic on cancer care services and overall (direct and indirect) excess deaths in people with cancer.Methods We employed near real-time weekly data on cancer care to determine the adverse effect of the pandemic on cancer services. We also used these data, together with national death registrations until June 2020 to model deaths, in excess of background (pre-COVID-19) mortality, in people with cancer. Background mortality risks for 24 cancers with and without COVID-19-relevant comorbidities were obtained from population-based primary care cohort (Clinical Practice Research Datalink) on 3 862 012 adults in England.Results Declines in urgent referrals (median=−70.4%) and chemotherapy attendances (median=−41.5%) to a nadir (lowest point) in the pandemic were observed. By 31 May, these declines have only partially recovered; urgent referrals (median=−44.5%) and chemotherapy attendances (median=−31.2%). There were short-term excess death registrations for cancer (without COVID-19), with peak relative risk (RR) of 1.17 at week ending on 3 April. The peak RR for all-cause deaths was 2.1 from week ending on 17 April. Based on these findings and recent literature, we modelled 40% and 80% of cancer patients being affected by the pandemic in the long-term. At 40% affected, we estimated 1-year total (direct and indirect) excess deaths in people with cancer as between 7165 and 17 910, using RRs of 1.2 and 1.5, respectively, where 78% of excess deaths occured in patients with ≥1 comorbidity.Conclusions Dramatic reductions were detected in the demand for, and supply of, cancer services which have not fully recovered with lockdown easing. These may contribute, over a 1-year time horizon, to substantial excess mortality among people with cancer and multimorbidity. It is urgent to understand how the recovery of general practitioner, oncology and other hospital services might best mitigate these long-term excess mortality risks.
