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Collateral damage: the impact on outcomes from cancer surgery of the COVID-19 pandemic.
Sud, A; Jones, M E; Broggio, J; Loveday, C; Torr, B; Garrett, A; Nicol, D L; Jhanji, S; Boyce, S A; Gronthoud, F; Ward, P; Handy, J M; Yousaf, N; Larkin, J; Suh, Y-E; Scott, S; Pharoah, P D P; Swanton, C; Abbosh, C; Williams, M; Lyratzopoulos, G; Houlston, R; Turnbull, C.
Afiliación
  • Sud A; Division of Genetics and Epidemiology, Institute of Cancer Research, London.
  • Jones ME; Division of Genetics and Epidemiology, Institute of Cancer Research, London.
  • Broggio J; National Cancer Registration and Analysis Service, Public Health England, Wellington House, London.
  • Loveday C; Division of Genetics and Epidemiology, Institute of Cancer Research, London.
  • Torr B; Division of Genetics and Epidemiology, Institute of Cancer Research, London.
  • Garrett A; Division of Genetics and Epidemiology, Institute of Cancer Research, London.
  • Nicol DL; Urology Unit, Royal Marsden NHS Foundation Trust, London.
  • Jhanji S; Department of Anaesthesia, Perioperative Medicine and Critical Care, Royal Marsden NHS Foundation Trust, London; Division of Cancer Biology, Institute of Cancer Research, London.
  • Boyce SA; Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford.
  • Gronthoud F; Department of Microbiology, Royal Marsden NHS Foundation Trust, London.
  • Ward P; Department of Anaesthesia, Perioperative Medicine and Critical Care, Royal Marsden NHS Foundation Trust, London.
  • Handy JM; Department of Anaesthesia, Perioperative Medicine and Critical Care, Royal Marsden NHS Foundation Trust, London.
  • Yousaf N; Lung Cancer Unit.
  • Larkin J; Skin and Renal Unit, Royal Marsden NHS Foundation Trust, London; Division of Clinical Studies, Institute of Cancer Research, London.
  • Suh YE; Department of Clinical Oncology, Royal Marsden NHS Foundation Trust, London.
  • Scott S; RM Partners, West London Cancer Alliance, Royal Marsden NHS Foundation Trust, London.
  • Pharoah PDP; Department of Public Health and Primary Care, University of Cambridge, Cambridge.
  • Swanton C; Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London; Cancer Evolution and Genome Instability Laboratory, University College London Cancer Institute, London.
  • Abbosh C; Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London; Cancer Evolution and Genome Instability Laboratory, University College London Cancer Institute, London.
  • Williams M; Department of Clinical Oncology, Imperial College Healthcare NHS Trust, London; Computational Oncology Group, Imperial College London, London.
  • Lyratzopoulos G; National Cancer Registration and Analysis Service, Public Health England, Wellington House, London; Epidemiology of Cancer Healthcare and Outcomes (ECHO) Group, University College London, London.
  • Houlston R; Division of Genetics and Epidemiology, Institute of Cancer Research, London; Department of Clinical Genetics, Royal Marsden NHS Foundation Trust, London, UK.
  • Turnbull C; Division of Genetics and Epidemiology, Institute of Cancer Research, London; National Cancer Registration and Analysis Service, Public Health England, Wellington House, London; Department of Clinical Genetics, Royal Marsden NHS Foundation Trust, London, UK. Electronic address: clare.turnbull@icr.ac.
Ann Oncol ; 31(8): 1065-1074, 2020 08.
Article en En | MEDLINE | ID: mdl-32442581
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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neumonía Viral / Infecciones por Coronavirus / Pandemias / Tiempo de Tratamiento / Betacoronavirus / Neoplasias Tipo de estudio: Diagnostic_studies / Observational_studies / Prognostic_studies Aspecto: Patient_preference Límite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Ann Oncol Asunto de la revista: NEOPLASIAS Año: 2020 Tipo del documento: Article Pais de publicación: Reino Unido

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neumonía Viral / Infecciones por Coronavirus / Pandemias / Tiempo de Tratamiento / Betacoronavirus / Neoplasias Tipo de estudio: Diagnostic_studies / Observational_studies / Prognostic_studies Aspecto: Patient_preference Límite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Ann Oncol Asunto de la revista: NEOPLASIAS Año: 2020 Tipo del documento: Article Pais de publicación: Reino Unido