Collateral damage: the impact on outcomes from cancer surgery of the COVID-19 pandemic.
Collateral damage: the impact on outcomes from cancer surgery of the COVID-19 pandemic.
复制标题
DOI：
10.1016/j.annonc.2020.05.009
复制
发表时间：
2020-08-01
期刊：
影响因子：
--
通讯作者：
Turnbull, C
中科院分区：
文献类型：
--
作者：
Sud, A;Jones, M E;Turnbull, C
背景技术背景：医疗服务对2019冠状病毒病（COVID-19）大流行的反应扰乱了癌症诊断和手术。延迟期间癌症的进展将影响患者的长期survival.PATIENTS和METHODS：我们从观察性研究中生成癌症进展的每日风险比，并将其应用于英格兰2013-2017年的年龄特异性，阶段特异性癌症存活率。我们模拟了每例患者3个月和6个月的延迟以及1年和2年的中断期。使用医疗保健资源成本计算，我们将癌症手术的可归因生命挽救和生命年增加（LYG）与COVID-19住院治疗的等效数量进行了对比。结果：每年，94 912例重大癌症切除术导致80 406例长期生存者和1 717 051例LYG。每例患者延迟3/6个月将导致4755/10760例患者的归因死亡，分别损失92214/208275生命年。对于癌症手术，标准条件下每例患者的平均LYG分别为18.1和17.1/15.9，延迟3/6个月（每例患者平均损失0.97/2.19 LYG）。考虑到医疗保健资源单位（HCRU），标准条件下每例患者的平均手术结果为2.25资源调整生命年（RALYG），延迟3/6个月后为2.12/1.97 RALYG。对于94912名住院COVID-19患者，有482022名LYG需要1052949名HCRU。社区获得性COVID-19患者的住院治疗平均每位患者产生5.08 LYG和0.46 RALYGs.Conclusions：癌症手术的适度延迟会对生存产生重大影响。对于偶发癌症，手术延迟3/6个月将分别减轻19%/43%的LYG，因为社区获得性COVID-19的住院量相等。当考虑RALYG时，这分别上升到26%/59%。为了避免可避免的癌症死亡的下游公共卫生危机，癌症诊断和手术途径必须保持正常的吞吐量，并迅速关注任何已经积累的积压。
BACKGROUND: Cancer diagnostics and surgery have been disrupted by the response of health care services to the coronavirus disease 2019 (COVID-19) pandemic. Progression of cancers during delay will impact on patients' long-term survival.PATIENTS AND METHODS: We generated per-day hazard ratios of cancer progression from observational studies and applied these to age-specific, stage-specific cancer survival for England 2013-2017. We modelled per-patient delay of 3 and 6 months and periods of disruption of 1 and 2 years. Using health care resource costing, we contextualise attributable lives saved and life-years gained (LYGs) from cancer surgery to equivalent volumes of COVID-19 hospitalisations.RESULTS: Per year, 94 912 resections for major cancers result in 80 406 long-term survivors and 1 717 051 LYGs. Per-patient delay of 3/6 months would cause attributable death of 4755/10 760 of these individuals with loss of 92 214/208 275 life-years, respectively. For cancer surgery, average LYGs per patient are 18.1 under standard conditions and 17.1/15.9 with a delay of 3/6 months (an average loss of 0.97/2.19 LYGs per patient), respectively. Taking into account health care resource units (HCRUs), surgery results on average per patient in 2.25 resource-adjusted life-years gained (RALYGs) under standard conditions and 2.12/1.97 RALYGs following delay of 3/6 months. For 94 912 hospital COVID-19 admissions, there are 482 022 LYGs requiring 1 052 949 HCRUs. Hospitalisation of community-acquired COVID-19 patients yields on average per patient 5.08 LYG and 0.46 RALYGs.CONCLUSIONS: Modest delays in surgery for cancer incur significant impact on survival. Delay of 3/6 months in surgery for incident cancers would mitigate 19%/43% of LYGs, respectively, by hospitalisation of an equivalent volume of admissions for community-acquired COVID-19. This rises to 26%/59%, respectively, when considering RALYGs. To avoid a downstream public health crisis of avoidable cancer deaths, cancer diagnostic and surgical pathways must be maintained at normal throughput, with rapid attention to any backlog already accrued.