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.
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.
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DOI：
10.1136/bmjopen-2020-043828
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发表时间：
2020-11-17
期刊：
影响因子：
2.9
通讯作者：
Hemingway H
中科院分区：
文献类型：
--
作者：
Lai AG;Pasea L;Banerjee A;Hall G;Denaxas S;Chang WH;Katsoulis M;Williams B;Pillay D;Noursadeghi M;Linch D;Hughes D;Forster MD;Turnbull C;Fitzpatrick NK;Boyd K;Foster GR;Enver T;Nafilyan V;Humberstone B;Neal RD;Cooper M;Jones M;Pritchard-Jones K;Sullivan R;Davie C;Lawler M;Hemingway H
评估新冠肺炎大流行对癌症护理服务和癌症患者总体(直接和间接)额外死亡的影响。我们使用了几乎实时的每周癌症护理数据来确定大流行对癌症服务的不利影响。我们还使用这些数据，以及截至2020年6月的全国死亡登记，对癌症患者的死亡进行建模，超过背景(新冠肺炎前)死亡率。背景：有和没有新冠肺炎相关合并症的24种癌症的死亡风险来自于基于人群的初级保健队列(临床实践研究数据链接)，研究对象是英国的3名 862 012成年人。紧急转诊(中位数=−70.4%)和化疗人次(中位数=−41.5%)下降到大流行的最低点(最低点)。截至5月31日，这些下降仅部分恢复；紧急转诊(中位数=−44.5%)和化疗就诊(中位数=−31.2%)。有短期的癌症超额死亡登记(没有新冠肺炎)，在4月3日结束的一周，相对风险(RR)为1.17。自4月17日结束的一周起，全死因死亡的最高相对危险度为2.1。基于这些发现和最近的文献，我们模拟了40%和80%的癌症患者在长期内受到大流行的影响。在40%受影响的情况下，我们估计癌症患者1年内(直接和间接)的额外死亡总数在7165至17910之间，使用的RR分别为1.2%和1.5%，其中78%的额外死亡发生在≥1共病患者中。癌症服务的需求和供应大幅减少，而随着封锁的放松，癌症服务尚未完全恢复。在一年的时间范围内，这些可能会导致癌症和多发病患者的大量超额死亡率。迫切需要了解全科医生、肿瘤学和其他医院服务的恢复如何才能最好地减轻这些长期过剩的死亡风险。
To estimate the impact of the COVID-19 pandemic on cancer care services and overall (direct and indirect) excess deaths in people with cancer. 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. 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. 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.
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