Disruption to diagnostic services and patients avoiding healthcare because of Covid-19 could see around 3,500 potentially avoidable deaths from the four main cancers in England, warn researchers.
They said urgent policy interventions were needed to deal with the backlog of patients awaiting routine diagnostic services and to reduce the cancer death toll attributable to the Covid-19 crisis.
They called for public health messaging that puts the risk of severe illness from Covid-19 into perspective compared with not seeking health-care advice for symptoms of cancer.
In addition, they urged evidence-based information to help healthcare workers manage the risks for patients with suspected cancer, as well as increasing both routine and urgent diagnostic capacity.
The UK modelling research, published in The Lancet Oncology journal, suggests 3,291 to 3,621 lives could be lost to breast, colorectal, oesophageal, and lung cancer over next five years due to delays.
Another UK study has found that, for many cancers, delays to treatment of two to six months will lead to a substantial proportion of patients with early-stage tumours progressing from curable to incurable disease.
During lockdown to combat the coronavirus pandemic, cancer screening and routine outpatient referral pathways were suspended, noted the London- based researchers behind the first study.
The only route to diagnosis was via an urgent two-week GP referral or presenting to an emergency department. Since physical distancing measures came in on 16 March, urgent referrals have fallen by as much as 80%.
The first study was conducted by researchers from London School of Hygiene and Tropical Medicine, King’s College London, and Guy’s and St Thomas’ NHS Foundation Trust.
Researchers analysed NHS cancer registration and hospital administrative data on over 93,000 patients diagnosed in 2010-12, to estimate the effect of delays in diagnosis on survival.
They modelled the impact of reallocating patients from usual screening and non-urgent routine referral pathways to urgent and emergency pathways for a year after physical distancing measures were introduced.
Their analysis suggest that delays in cancer diagnosis and changes in health-seeking behaviour could result in breast cancer deaths increasing by an estimated 8-10%.
For colorectal cancer deaths could rise by 15-17%, while there could be a 5% rise in lung cancer deaths, and a 6% rise in deaths from oesophageal cancer over the next five years.
Lead author Dr Ajay Aggarwal, from the London School of Hygiene and Tropical Medicine, said: “Our findings demonstrate the impact of the national Covid-19 response.
“Whilst currently attention is being focused on diagnostic pathways where cancer is suspected, the issue is that a significant number of cancers are diagnosed in patients awaiting investigation for symptoms not considered related to be cancer.
“Therefore, we need a whole system approach to avoid the predicted excess deaths,” said Dr Aggarwal.
In a second paper, researchers from 13 UK centres, including trusts and universities, examined the impact of backlog in cancer referrals during the lockdown on cancer survival.
Modelling different possible volumes of backlog, based on 10-year cancer survival estimates for patients in England for 20 common cancers diagnosed in 2008-17, they estimated deaths due to delays in diagnosis via the urgent two-week referral pathway during the Covid-19 crisis.
The model predicts 181 to 542 additional cancer deaths due to delay in patient presentation and referral during the three-month lockdown, and a further 401 to 1,231 deaths due to delayed diagnostic investigation dealing with this backlog of patients.
The findings also suggest that Covid-19-related delays in presentation, diagnosis, and subsequent treatment will result in additional deaths and years of life lost that vary widely according to patient age and type of cancer.
Lead author Professor Clare Turnbull, from the Institute of Cancer Research, said delays in diagnosis and treatment of just two months could lead to a “substantial proportion of patients with early-stage tumours progressing from having curable to incurable disease”.
She added: “Substantial additional deaths from diagnostic delays on top of those expected from delays in presentation… are likely, especially if rapid provision of additional capacity, including technical provision and increased staffing, is not forthcoming.”
“Prioritising patients for whom delay would result in most life-years lost may be considered a reasonable option for reducing the overall burden of mortality,” said Professor Turnbull.
Writing in a linked comment the same journal, Professor William Hamilton, from the University of Exeter, suggested how Nightingale hospitals might help address the backlog of diagnostic care.
He said: “Imaging departments might not be able to meet increased demand: many were working at full capacity before the Covid-19 pandemic.
“There are encouraging reports that the Nightingale hospitals – which were rapidly built to offer care for patients with Covid-19, but are now less needed – will be reconfigured into cancer diagnostic hubs.”
He added: “The UK has had a long-term shortage of diagnostic capacity, although this shortage is not simply of equipment, but also of personnel, which is not so easily improved.”