Impact of COVID-19 on Outcomes for Patients With Cervical Cancer in India.
Impact of COVID-19 on Outcomes for Patients With Cervical Cancer in India.
复制标题
DOI：
10.1200/go.20.00654
复制
发表时间：
2021-05
影响因子：
4.5
通讯作者：
Pandey AK
中科院分区：
文献类型：
--
作者：
Gupta N;Chauhan AS;Prinja S;Pandey AK
COVID-19疫情对卫生系统提出了前所未有的要求。这导致癌症治疗的开始和完成延迟。我们评估了印度因COVID-19导致宫颈癌诊断和治疗延迟的长期健康后果。我们使用了基于马尔可夫模型的分析，评估了印度宫颈癌风险女性人群队列的终身健康结果。根据治疗延长超过标准持续时间的天数计算治疗中断患者的生存率下降。此外，为了模拟延迟诊断和延迟治疗开始的影响，根据疾病的自然进展，假设患者在延迟期内提前分期。我们估计，与无延迟相比，在治疗限制范围为9周至6个月的情况下，宫颈癌导致的死亡将增加2.52%（n = 795）至3.80%（n = 2，160）。相反，在此限制期内，估计可挽救88-238名因COVID-19疾病死亡的宫颈癌患者。总体而言，宫颈癌造成的超额死亡率导致18，159 - 53，626生命年的损失和16，808 - 50，035残疾调整生命年的增加。与宫颈癌患者避免的COVID-19死亡率相比，诊断和治疗的延误可能导致更多宫颈癌死亡。卫生系统必须在确定提供护理的优先事项方面进行重组，首先是优先治疗早期宫颈癌患者，增加远程咨询的使用，并加强初级保健医生在提供癌症护理方面的作用。
The COVID-19 pandemic has placed unprecedented demands on the health system. This led to delays in the initiation and completion of cancer treatment. We assessed the long-term health consequences because of the delay in diagnosis and treatment for cervical cancer due to COVID-19 in India. We used a Markov-model–based analysis assessing the lifetime health outcomes of the cohort of women population at risk from cervical cancer in India. The decrease in survival for those with the treatment interruption was calculated based on the number of days the treatment was extended beyond the standard duration. Furthermore, to model the impact of late diagnosis and delayed treatment initiation, the patients were assumed to have upstaged during the delay period, as per natural progression of disease. We estimate 2.52% (n = 795) to 3.80% (n = 2,160) lifetime increase in the deaths caused by cervical cancer with treatment restrictions ranging from 9 weeks to 6 months, respectively, as compared to no delay. On the contrary, 88-238 deaths because of COVID-19 disease are estimated to be saved during this restriction period among the patients with cervical cancer. Overall, the excess mortality because of cervical cancer led to 18,159-53,626 life-years being lost and an increase of 16,808-50,035 disability-adjusted life-years. Delays in diagnosis and treatment are likely to lead to more cervical cancer deaths as compared to COVID-19 mortality averted among the patients with cervical cancer. Health systems must reorganize in terms of priority setting for provision of care, starting with prioritizing the treatment of patients with early-stage cervical cancer, increasing use of teleconsultation, and strengthening the role of primary care physicians in provision of cancer care.