IHI-led research shows COVID-19 emergency could lead to 18,000 more deaths in people with cancer
29 April 2020
A major new study published today, led by researchers at the UCL Institute of Health Informatics with DATA-CAN: The Health Data Research Hub for Cancer, shows significant changes to cancer services as a result of the COVID-19 emergency and a worrying increase in the number of deaths in people with cancer which may be attributed to the indirect adverse impact of the pandemic and deaths directly due to COVID-19.
The study is the first to model excess deaths in the COVID-19 emergency in patients with cancer and other underlying health conditions, including cardiovascular diseases, hypertension, obesity and diabetes.
Researchers analysed the electronic health records of nearly 4 million patients in England to estimate the effects of the COVID-19 emergency on 1-year mortality. They based their model on the likely assumption that COVID-19 will affect the health and wellbeing of 40% of the population, estimating there could be 6,270 more deaths among newly diagnosed cancer patients alone over the next year – a 20% increase in deaths among people newly diagnosed with cancer. This number could rise to an estimated 17,915 additional deaths if all people currently living with cancer are considered. More than three quarters of these excess deaths will occur in people who are also suffering from one or more other underlying health condition. The excess risk of death in people living with cancer may be due to COVID-19 infection as well as the unintended health consequences of changes in health service provision, the physical or psychological effects of social distancing, and economic upheaval.
The study also modelled publicly available data in the US to estimate that pre-COVID-19, about 169,433 newly diagnosed cancer patients would die within a year in the US. This figure rose to an additional 33,890 deaths in the US in newly diagnosed cancer patients over the next year as a result of COVID.
The research team, consisting of biostatisticians, clinicians and scientists, also analysed weekly returns for chemotherapy attendances and urgent cancer referrals based on data from hospitals in Leeds, London and Northern Ireland, and observed worrying, major declines in admissions for chemotherapy (60%) and urgent referrals for early cancer diagnosis (76%) compared to pre-emergency levels.
Senior author Professor Harry Hemingway, Director, UCL Institute of Health Informatics said: “The overall impact of the COVID-19 emergency on deaths in cancer patients could be substantial. There are many factors operating here including rapid changes to diagnosis and treatment protocols, social distancing measures, changes in people’s behaviour in seeking medical attention and the economic impact of COVID-19, as well as deaths due to COVID-19 infection.”
Lead author Dr Alvina Lai, Lecturer in Health Data Analytics and Cancer Informatics, UCL Institute of Health Informatics said: “These figures demonstrate the serious potential for unintended consequences of the response to the COVID-19 pandemic, which may negatively impact on patients with cancer and other underlying health conditions. It is vital that these patients are recognised as being vulnerable and that their care is managed appropriately”.
The study findings highlighted how cancer patients with multimorbidy are a particularly vulnerable group during the current pandemic. The team suggest that in order to ensure effective cancer policy and avoid excess deaths during and after the COVID-19 emergency, there is an urgent need for near-real time weekly reporting of cause-specific excess mortality, cancer diagnosis and treatment and data on use of effective treatments for existing health conditions in cancer patients.
Funding for the study was provided from Health Data Research UK (HDRUK), and the National Institute of Health Research (NIHR) University College London Hospitals Biomedical Research Centre.
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