The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population-based, modelling study
The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population-based, modelling study
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DOI：
10.1016/s1470-2045(20)30388-0
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发表时间：
2020-08-01
期刊：
影响因子：
51.1
通讯作者：
Aggarwal, Ajay
中科院分区：
文献类型：
--
作者：
Maringe, Camille;Spicer, James;Aggarwal, Ajay
背景自2020年3月英国为应对新冠肺炎大流行而实施全国封锁以来，癌症筛查已暂停，常规诊断工作被推迟，只有紧急症状病例优先进行诊断干预。在这项研究中，我们评估了诊断延迟对四种主要肿瘤类型癌症生存结果的影响。方法在这项基于人群的模拟研究中，我们使用了链接的英国国民健康服务(NHS)癌症登记和医院管理数据集，年龄15-84岁，2010年1月1日至2010年12月31日被诊断为乳腺癌、结直肠癌和食道癌，随访数据至2014年12月31日，以及2012年1月1日至2012年12月31日被诊断为肺癌，随访数据至2015年12月31日。我们使用路径诊断框架来估计诊断延迟在物理距离措施开始后12个月内的影响，从2020年3月16日开始，直到诊断后1年、3年和5年。为了模拟诊断延迟对存活率的后续影响，我们将接受筛查和常规转诊路径的患者重新分配到与诊断时更晚期的疾病相关的紧急和紧急路径。我们考虑了三种重新分配情景，代表了从最好到最坏的情景，并反映了截至2020年3月16日在NHS中看到的诊断路径的实际变化，并估计了诊断后1、3和5年对净生存率的影响，以计算可归因于癌症的额外死亡以及与大流行前相比的总寿命损失年数(YLL)。我们收集了32 583名乳腺癌患者、24 975名结直肠癌患者、6744名食道癌患者和29 305名肺癌患者的数据。在三种不同的情况下，与大流行前的数字相比，我们估计为7.9-9。截至确诊后第5年，乳腺癌死亡人数增加了6%，相当于增加了281人(95%可信区间266-295)至344人(329-358)的死亡人数。对于结直肠癌，我们估计增加了1445(1392-1591)至1563(1534-1592)例死亡，15.3-16例。6%；肺癌，1235例(1220-1254)至1372例(1343-1401)，增加4.8-5.3%；食道癌330例(324-335例)至342例(336-348例)，确诊后5年内增加5840%。对于这四种肿瘤类型，这些数据对应着5年内在所有情景中增加的3291-3621例死亡。据估计，这些癌症的YLL总数增加了59 204-63 229年。解释由于英国新冠肺炎大流行导致的诊断延误，英国可避免的癌症死亡人数预计将大幅增加。需要紧急的政策干预，特别是需要管理常规诊断服务中的积压，以减轻新冠肺炎大流行对癌症患者的预期影响。版权所有(C)2020作者(S)。爱思唯尔有限公司出版。
Background Since a national lockdown was introduced across the UK in March, 2020, in response to the COVID-19 pandemic, cancer screening has been suspended, routine diagnostic work deferred, and only urgent symptomatic cases prioritised for diagnostic intervention. In this study, we estimated the impact of delays in diagnosis on cancer survival outcomes in four major tumour types.Methods In this national population-based modelling study, we used linked English National Health Service (NHS) cancer registration and hospital administrative datasets for patients aged 15-84 years, diagnosed with breast, colorectal, and oesophageal cancer between Jan 1, 2010, and Dec 31, 2010, with follow-up data until Dec 31, 2014, and diagnosed with lung cancer between Jan 1, 2012, and Dec 31, 2012, with follow-up data until Dec 31, 2015. We use a routes-to-diagnosis framework to estimate the impact of diagnostic delays over a 12-month period from the commencement of physical distancing measures, on March 16, 2020, up to 1, 3, and 5 years after diagnosis. To model the subsequent impact of diagnostic delays on survival, we reallocated patients who were on screening and routine referral pathways to urgent and emergency pathways that are associated with more advanced stage of disease at diagnosis. We considered three reallocation scenarios representing the best to worst case scenarios and reflect actual changes in the diagnostic pathway being seen in the NHS, as of March 16, 2020, and estimated the impact on net survival at 1, 3, and 5 years after diagnosis to calculate the additional deaths that can be attributed to cancer, and the total years of life lost (YLLs) compared with pre-pandemic data.Findings We collected data for 32 583 patients with breast cancer, 24 975 with colorectal cancer, 6744 with oesophageal cancer, and 29 305 with lung cancer. Across the three different scenarios, compared with pre-pandemic figures, we estimate a 7. 9-9. 6% increase in the number of deaths due to breast cancer up to year 5 after diagnosis, corresponding to between 281 (95% CI 266-295) and 344 (329-358) additional deaths. For colorectal cancer, we estimate 1445 (1392-1591) to 1563 (1534-1592) additional deaths, a 15 .3-16. 6% increase; for lung cancer, 1235 (1220-1254) to 1372 (1343-1401) additional deaths, a 4.8-5.3% increase; and for oesophageal cancer, 330 (324-335) to 342 (336-348) additional deaths, 5 84 0% increase up to 5 years after diagnosis. For these four tumour types, these data correspond with 3291-3621 additional deaths across the scenarios within 5 years. The total additional YLLs across these cancers is estimated to be 59 204-63 229 years.Interpretation Substantial increases in the number of avoidable cancer deaths in England are to be expected as a result of diagnostic delays due to the COVID-19 pandemic in the UK. Urgent policy interventions are necessary, particularly the need to manage the backlog within routine diagnostic services to mitigate the expected impact of the COVID-19 pandemic on patients with cancer. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd.