24 June 2020

tranScrip previously reported on the considerations for optimal cancer care provision during the COVID-19 pandemic [1]. The report predicted a likely increase in cancer deaths worldwide over the next 12 to 18 months resulting from curtailments to diagnostic procedures and life-saving treatments. A major new study, published in Annals of Oncology and conducted by scientists at the Institute of Cancer Research (ICR), analysed existing Public Health England data (within the United Kingdom) of delays to cancer surgery on patients’ five-year survival rates to estimate the effect of three-month or six-month delays, respectively [2]. They warn that COVID-19 pandemic-related delays to treatment and surgery for cancer patients could be responsible for thousands of deaths. According to the team's findings, a delay of three months across all 94,912 patients who, over the course of a year, would have had surgery to remove their cancer, would lead to an additional 4,755 deaths. This would increase to 10,760 excess deaths for a six-month delay. An extrapolation of these estimates into worldwide potential excess deaths suggests a profound negative impact on global cancer survival.

An additional and pressing concern is the impact on cancer prognoses for those patients who are diagnosed with COVID-19 infection. Recently, Lee et al [3] have reported on a population of 800 patients in the UK with a diagnosis of cancer and symptomatic COVID-19, confirmed by RT PCR, where 52% patients had mild COVID-19 disease and 28% patients died. Of the 28% of patients who died, 93% of these deaths were principally attributable to COVID-19 infection and 88% of overall deaths in the study were patients who were classified with severe or critical COVID-19 infection. The risk of death was significantly associated with advancing patient age (odds ratio 9.42 [95% CI 6.56 10.02]; p<0.0001), being male (1.67 [1.19–2.34]; p=0.003), and the presence of other comorbidities such as hypertension (1.95 [1.36–2.80]; p<0.001) and cardiovascular disease (2.32 [1.47–3·64]). In this study, 281 (35%) patients had received cytotoxic chemotherapy within four weeks before testing positive for COVID-19. After adjusting for age, gender, and comorbidities, it was concluded that chemotherapy in the past four weeks had no significant effect on mortality from COVID-19 disease, when compared with patients with cancer who had not received recent chemotherapy (1.18 [0.81–1.72]; p=0.380). Similarly, no significant effect on mortality was observed for patients treated with immunotherapy, hormonal therapy, targeted therapy, or radiotherapy within the past four weeks. 

The European Society of Medical Oncology (ESMO) highlights that ‘older people are more vulnerable, with underlying health conditions such as chronic respiratory, cardio-vascular or chronic kidney disease, diabetes, active cancer and more generally severe chronic diseases’ [4]. Therefore, ESMO advises a benefit risk assessment for cancer patients during the pandemic to ensure safe and optimal care. The American Society of Clinical Oncology has produced a special report to guide cancer care delivery in the COVID-19 pandemic. However, while further data are needed to better understand the impact of COVID-19 on cancer outcomes, the recent data from Lee et al. [3] provide some assurances that timely treatment for cancer, itself a severe and life-threatening condition, should take precedence over the risk of contracting COVID-19.

Bibliography

  1. Summerton L, Bowers D. Delivering Optimal Cancer Care During the Covid-19 Pandemic: tranScrip Partners; 2020 [updated 09 April 2020; cited 2020 03 June 2020]. Available from: https://www.transcrip-partners.com/news/delivering-optimal-cancer-care-during-covid-19-pandemic. 2020.
  2. Sud A, Jones M, Broggio J et al. Collateral damage: the impact on outcomes from cancer surgery of the COVID-19 pandemic. Ann Oncol 2020.
  3. Lee LYW, Cazier JB, Starkey T et al. COVID-19 mortality in patients with cancer on chemotherapy or other anticancer treatments: a prospective cohort study. The Lancet 2020.
  4. ESMO. Cancer Patient Management During the COVID-19 Pandemic. https://www.esmo.org/guidelines/cancer-patient-management-during-the-covid-19-pandemic (accessed 19 June 2020).
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