Estimated impact of the COVID-19 pandemic on cancer services and excess 1-year mortality in people with cancer and multimorbidity: near real-time data on cancer care, cancer deaths and a population-based cohort study
ObjectivesTo estimate the impact of the COVID-19 pandemic on cancer care services and overall (direct and indirect) excess deaths in people with cancer.MethodsWe employed near real-time weekly data on cancer care to determine the adverse effect of the pandemic on cancer services. We also used these...
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| Veröffentlicht in: | BMJ open 2020-11, Vol.10 (11), p.e043828-e043828 |
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| creator | Lai, Alvina G Pasea, Laura Banerjee, Amitava Hall, Geoff Denaxas, Spiros Chang, Wai Hoong Katsoulis, Michail Williams, Bryan Pillay, Deenan Noursadeghi, Mahdad Linch, David Hughes, Derralynn Forster, Martin D Turnbull, Clare Fitzpatrick, Natalie K Boyd, Kathryn Foster, Graham R Enver, Tariq Nafilyan, Vahe Humberstone, Ben Neal, Richard D Cooper, Matt Jones, Monica Pritchard-Jones, Kathy Sullivan, Richard Davie, Charlie Lawler, Mark Hemingway, Harry |
| description | ObjectivesTo estimate the impact of the COVID-19 pandemic on cancer care services and overall (direct and indirect) excess deaths in people with cancer.MethodsWe employed near real-time weekly data on cancer care to determine the adverse effect of the pandemic on cancer services. We also used these data, together with national death registrations until June 2020 to model deaths, in excess of background (pre-COVID-19) mortality, in people with cancer. Background mortality risks for 24 cancers with and without COVID-19-relevant comorbidities were obtained from population-based primary care cohort (Clinical Practice Research Datalink) on 3 862 012 adults in England.ResultsDeclines in urgent referrals (median=−70.4%) and chemotherapy attendances (median=−41.5%) to a nadir (lowest point) in the pandemic were observed. By 31 May, these declines have only partially recovered; urgent referrals (median=−44.5%) and chemotherapy attendances (median=−31.2%). There were short-term excess death registrations for cancer (without COVID-19), with peak relative risk (RR) of 1.17 at week ending on 3 April. The peak RR for all-cause deaths was 2.1 from week ending on 17 April. Based on these findings and recent literature, we modelled 40% and 80% of cancer patients being affected by the pandemic in the long-term. At 40% affected, we estimated 1-year total (direct and indirect) excess deaths in people with cancer as between 7165 and 17 910, using RRs of 1.2 and 1.5, respectively, where 78% of excess deaths occured in patients with ≥1 comorbidity.ConclusionsDramatic reductions were detected in the demand for, and supply of, cancer services which have not fully recovered with lockdown easing. These may contribute, over a 1-year time horizon, to substantial excess mortality among people with cancer and multimorbidity. It is urgent to understand how the recovery of general practitioner, oncology and other hospital services might best mitigate these long-term excess mortality risks. |
| doi_str_mv | 10.1136/bmjopen-2020-043828 |
| format | Article |
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We also used these data, together with national death registrations until June 2020 to model deaths, in excess of background (pre-COVID-19) mortality, in people with cancer. Background mortality risks for 24 cancers with and without COVID-19-relevant comorbidities were obtained from population-based primary care cohort (Clinical Practice Research Datalink) on 3 862 012 adults in England.ResultsDeclines in urgent referrals (median=−70.4%) and chemotherapy attendances (median=−41.5%) to a nadir (lowest point) in the pandemic were observed. By 31 May, these declines have only partially recovered; urgent referrals (median=−44.5%) and chemotherapy attendances (median=−31.2%). There were short-term excess death registrations for cancer (without COVID-19), with peak relative risk (RR) of 1.17 at week ending on 3 April. The peak RR for all-cause deaths was 2.1 from week ending on 17 April. Based on these findings and recent literature, we modelled 40% and 80% of cancer patients being affected by the pandemic in the long-term. At 40% affected, we estimated 1-year total (direct and indirect) excess deaths in people with cancer as between 7165 and 17 910, using RRs of 1.2 and 1.5, respectively, where 78% of excess deaths occured in patients with ≥1 comorbidity.ConclusionsDramatic reductions were detected in the demand for, and supply of, cancer services which have not fully recovered with lockdown easing. These may contribute, over a 1-year time horizon, to substantial excess mortality among people with cancer and multimorbidity. It is urgent to understand how the recovery of general practitioner, oncology and other hospital services might best mitigate these long-term excess mortality risks.</description><identifier>ISSN: 2044-6055</identifier><identifier>EISSN: 2044-6055</identifier><identifier>DOI: 10.1136/bmjopen-2020-043828</identifier><identifier>PMID: 33203640</identifier><language>eng</language><publisher>England: British Medical Journal Publishing Group</publisher><subject>Adult ; Cancer ; Cause of Death - trends ; Chemotherapy ; Clinical medicine ; Cohort analysis ; Comorbidity ; Coronaviruses ; COVID-19 ; COVID-19 - epidemiology ; Electronic health records ; England - epidemiology ; Estimates ; Female ; Follow-Up Studies ; health informatics ; Health services ; Hospitals ; Humans ; Infections ; Lymphoma ; Male ; Medical diagnosis ; Medical screening ; Middle Aged ; Models, Statistical ; Mortality ; Multimorbidity - trends ; Neoplasms - epidemiology ; Oncology ; Pandemics ; Population ; Population Surveillance ; Population-based studies ; Practice research ; Primary care ; Public health ; SARS-CoV-2 ; Severe acute respiratory syndrome coronavirus 2 ; Survival Rate - trends ; Time Factors</subject><ispartof>BMJ open, 2020-11, Vol.10 (11), p.e043828-e043828</ispartof><rights>Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.</rights><rights>2020 Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ. 2020</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b578t-f06559c8690e4d7f012973a28a344c9a4aea99686c97ad92959e4178e68d4d4d3</citedby><cites>FETCH-LOGICAL-b578t-f06559c8690e4d7f012973a28a344c9a4aea99686c97ad92959e4178e68d4d4d3</cites><orcidid>0000-0001-8960-8095 ; 0000-0001-8741-3411 ; 0000-0003-2279-0624 ; 0000-0003-0160-217X ; 0000-0002-1734-5772 ; 0000-0002-8094-1841</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://bmjopen.bmj.com/content/10/11/e043828.full.pdf$$EPDF$$P50$$Gbmj$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://bmjopen.bmj.com/content/10/11/e043828.full$$EHTML$$P50$$Gbmj$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,27526,27527,27901,27902,53766,53768,55325,77344,77375,77403,77429</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33203640$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lai, Alvina G</creatorcontrib><creatorcontrib>Pasea, Laura</creatorcontrib><creatorcontrib>Banerjee, Amitava</creatorcontrib><creatorcontrib>Hall, Geoff</creatorcontrib><creatorcontrib>Denaxas, Spiros</creatorcontrib><creatorcontrib>Chang, Wai Hoong</creatorcontrib><creatorcontrib>Katsoulis, Michail</creatorcontrib><creatorcontrib>Williams, Bryan</creatorcontrib><creatorcontrib>Pillay, Deenan</creatorcontrib><creatorcontrib>Noursadeghi, Mahdad</creatorcontrib><creatorcontrib>Linch, David</creatorcontrib><creatorcontrib>Hughes, Derralynn</creatorcontrib><creatorcontrib>Forster, Martin D</creatorcontrib><creatorcontrib>Turnbull, Clare</creatorcontrib><creatorcontrib>Fitzpatrick, Natalie K</creatorcontrib><creatorcontrib>Boyd, Kathryn</creatorcontrib><creatorcontrib>Foster, Graham R</creatorcontrib><creatorcontrib>Enver, Tariq</creatorcontrib><creatorcontrib>Nafilyan, Vahe</creatorcontrib><creatorcontrib>Humberstone, Ben</creatorcontrib><creatorcontrib>Neal, Richard D</creatorcontrib><creatorcontrib>Cooper, Matt</creatorcontrib><creatorcontrib>Jones, Monica</creatorcontrib><creatorcontrib>Pritchard-Jones, Kathy</creatorcontrib><creatorcontrib>Sullivan, Richard</creatorcontrib><creatorcontrib>Davie, Charlie</creatorcontrib><creatorcontrib>Lawler, Mark</creatorcontrib><creatorcontrib>Hemingway, Harry</creatorcontrib><title>Estimated impact of the COVID-19 pandemic on cancer services and excess 1-year mortality in people with cancer and multimorbidity: near real-time data on cancer care, cancer deaths and a population-based cohort study</title><title>BMJ open</title><addtitle>BMJ Open</addtitle><addtitle>BMJ Open</addtitle><description>ObjectivesTo estimate the impact of the COVID-19 pandemic on cancer care services and overall (direct and indirect) excess deaths in people with cancer.MethodsWe employed near real-time weekly data on cancer care to determine the adverse effect of the pandemic on cancer services. We also used these data, together with national death registrations until June 2020 to model deaths, in excess of background (pre-COVID-19) mortality, in people with cancer. Background mortality risks for 24 cancers with and without COVID-19-relevant comorbidities were obtained from population-based primary care cohort (Clinical Practice Research Datalink) on 3 862 012 adults in England.ResultsDeclines in urgent referrals (median=−70.4%) and chemotherapy attendances (median=−41.5%) to a nadir (lowest point) in the pandemic were observed. By 31 May, these declines have only partially recovered; urgent referrals (median=−44.5%) and chemotherapy attendances (median=−31.2%). There were short-term excess death registrations for cancer (without COVID-19), with peak relative risk (RR) of 1.17 at week ending on 3 April. The peak RR for all-cause deaths was 2.1 from week ending on 17 April. Based on these findings and recent literature, we modelled 40% and 80% of cancer patients being affected by the pandemic in the long-term. At 40% affected, we estimated 1-year total (direct and indirect) excess deaths in people with cancer as between 7165 and 17 910, using RRs of 1.2 and 1.5, respectively, where 78% of excess deaths occured in patients with ≥1 comorbidity.ConclusionsDramatic reductions were detected in the demand for, and supply of, cancer services which have not fully recovered with lockdown easing. These may contribute, over a 1-year time horizon, to substantial excess mortality among people with cancer and multimorbidity. It is urgent to understand how the recovery of general practitioner, oncology and other hospital services might best mitigate these long-term excess mortality risks.</description><subject>Adult</subject><subject>Cancer</subject><subject>Cause of Death - trends</subject><subject>Chemotherapy</subject><subject>Clinical medicine</subject><subject>Cohort analysis</subject><subject>Comorbidity</subject><subject>Coronaviruses</subject><subject>COVID-19</subject><subject>COVID-19 - epidemiology</subject><subject>Electronic health records</subject><subject>England - epidemiology</subject><subject>Estimates</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>health informatics</subject><subject>Health services</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Infections</subject><subject>Lymphoma</subject><subject>Male</subject><subject>Medical diagnosis</subject><subject>Medical screening</subject><subject>Middle Aged</subject><subject>Models, Statistical</subject><subject>Mortality</subject><subject>Multimorbidity - trends</subject><subject>Neoplasms - epidemiology</subject><subject>Oncology</subject><subject>Pandemics</subject><subject>Population</subject><subject>Population Surveillance</subject><subject>Population-based studies</subject><subject>Practice research</subject><subject>Primary care</subject><subject>Public health</subject><subject>SARS-CoV-2</subject><subject>Severe acute respiratory syndrome coronavirus 2</subject><subject>Survival Rate - trends</subject><subject>Time Factors</subject><issn>2044-6055</issn><issn>2044-6055</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>9YT</sourceid><sourceid>ACMMV</sourceid><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNqNUstu1DAUjRCIVqVfgIQssWFBWttxnJgFUjUUGKlSN8DWuuPcdDxK4mA7hflTPgdP58GUBcJe-No-Dz9Olr1k9IKxQl4u-pUbccg55TSnoqh5_SQ75VSIXNKyfHpUn2TnIaxoaqJUZcmfZydFwWkhBT3Nfl2HaHuI2BDbj2AicS2JSySz22_zDzlTZIShwd4a4gZiYDDoSUB_bw0GkrYI_kxVICxfI3jSOx-hs3FN7EBGdGOH5IeNyz11w-inLnk6v7BNAr4jw4boEbo8LSNpIMKRmQGPb_eTBiEut75ARjdOHUTrhnwBId3AuGWyJyFOzfpF9qyFLuD5bjzLvn68_jL7nN_cfprPrm7yRVnVMW-pLEtlaqkoiqZqKeOqKoDXUAhhFAhAUErW0qgKGsVVqVCwqkZZNyL14iybb3UbBys9-vSYfq0dWP2w4PydBh-t6VAb3komJRdtlb6iZAsq6ySHTJVCJYOk9X6rNU6LHhuDQ_TQPRJ9vDPYpb5z97qSlUhBSAJvdgLefZ8wRN3bYLDrYEA3Bc2FZLVkBa0S9PVf0JWb_JCe6gHFKqE4S6hiizLeheCxPRyGUb0Jot4FUW-CqLdBTKxXx_c4cPaxS4CLLSCx_1Px8g_hcNB_MX4D-z36dw</recordid><startdate>20201117</startdate><enddate>20201117</enddate><creator>Lai, Alvina G</creator><creator>Pasea, Laura</creator><creator>Banerjee, Amitava</creator><creator>Hall, Geoff</creator><creator>Denaxas, Spiros</creator><creator>Chang, Wai Hoong</creator><creator>Katsoulis, Michail</creator><creator>Williams, Bryan</creator><creator>Pillay, Deenan</creator><creator>Noursadeghi, Mahdad</creator><creator>Linch, David</creator><creator>Hughes, Derralynn</creator><creator>Forster, Martin D</creator><creator>Turnbull, Clare</creator><creator>Fitzpatrick, Natalie K</creator><creator>Boyd, Kathryn</creator><creator>Foster, Graham R</creator><creator>Enver, Tariq</creator><creator>Nafilyan, Vahe</creator><creator>Humberstone, Ben</creator><creator>Neal, Richard D</creator><creator>Cooper, Matt</creator><creator>Jones, Monica</creator><creator>Pritchard-Jones, Kathy</creator><creator>Sullivan, Richard</creator><creator>Davie, Charlie</creator><creator>Lawler, Mark</creator><creator>Hemingway, Harry</creator><general>British Medical Journal Publishing Group</general><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group</general><scope>9YT</scope><scope>ACMMV</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>COVID</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>NAPCQ</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0001-8960-8095</orcidid><orcidid>https://orcid.org/0000-0001-8741-3411</orcidid><orcidid>https://orcid.org/0000-0003-2279-0624</orcidid><orcidid>https://orcid.org/0000-0003-0160-217X</orcidid><orcidid>https://orcid.org/0000-0002-1734-5772</orcidid><orcidid>https://orcid.org/0000-0002-8094-1841</orcidid></search><sort><creationdate>20201117</creationdate><title>Estimated impact of the COVID-19 pandemic on cancer services and excess 1-year mortality in people with cancer and multimorbidity: near real-time data on cancer care, cancer deaths and a population-based cohort study</title><author>Lai, Alvina G ; Pasea, Laura ; Banerjee, Amitava ; Hall, Geoff ; Denaxas, Spiros ; Chang, Wai Hoong ; Katsoulis, Michail ; Williams, Bryan ; Pillay, Deenan ; Noursadeghi, Mahdad ; Linch, David ; Hughes, Derralynn ; Forster, Martin D ; Turnbull, Clare ; Fitzpatrick, Natalie K ; Boyd, Kathryn ; Foster, Graham R ; Enver, Tariq ; Nafilyan, Vahe ; Humberstone, Ben ; Neal, Richard D ; Cooper, Matt ; Jones, Monica ; Pritchard-Jones, Kathy ; Sullivan, Richard ; Davie, Charlie ; Lawler, Mark ; Hemingway, Harry</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b578t-f06559c8690e4d7f012973a28a344c9a4aea99686c97ad92959e4178e68d4d4d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adult</topic><topic>Cancer</topic><topic>Cause of Death - trends</topic><topic>Chemotherapy</topic><topic>Clinical medicine</topic><topic>Cohort analysis</topic><topic>Comorbidity</topic><topic>Coronaviruses</topic><topic>COVID-19</topic><topic>COVID-19 - epidemiology</topic><topic>Electronic health records</topic><topic>England - epidemiology</topic><topic>Estimates</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>health informatics</topic><topic>Health services</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Infections</topic><topic>Lymphoma</topic><topic>Male</topic><topic>Medical diagnosis</topic><topic>Medical screening</topic><topic>Middle Aged</topic><topic>Models, Statistical</topic><topic>Mortality</topic><topic>Multimorbidity - trends</topic><topic>Neoplasms - epidemiology</topic><topic>Oncology</topic><topic>Pandemics</topic><topic>Population</topic><topic>Population Surveillance</topic><topic>Population-based studies</topic><topic>Practice research</topic><topic>Primary care</topic><topic>Public health</topic><topic>SARS-CoV-2</topic><topic>Severe acute respiratory syndrome coronavirus 2</topic><topic>Survival Rate - trends</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lai, Alvina G</creatorcontrib><creatorcontrib>Pasea, Laura</creatorcontrib><creatorcontrib>Banerjee, Amitava</creatorcontrib><creatorcontrib>Hall, Geoff</creatorcontrib><creatorcontrib>Denaxas, Spiros</creatorcontrib><creatorcontrib>Chang, Wai Hoong</creatorcontrib><creatorcontrib>Katsoulis, Michail</creatorcontrib><creatorcontrib>Williams, Bryan</creatorcontrib><creatorcontrib>Pillay, Deenan</creatorcontrib><creatorcontrib>Noursadeghi, Mahdad</creatorcontrib><creatorcontrib>Linch, David</creatorcontrib><creatorcontrib>Hughes, Derralynn</creatorcontrib><creatorcontrib>Forster, Martin D</creatorcontrib><creatorcontrib>Turnbull, Clare</creatorcontrib><creatorcontrib>Fitzpatrick, Natalie K</creatorcontrib><creatorcontrib>Boyd, Kathryn</creatorcontrib><creatorcontrib>Foster, Graham R</creatorcontrib><creatorcontrib>Enver, Tariq</creatorcontrib><creatorcontrib>Nafilyan, Vahe</creatorcontrib><creatorcontrib>Humberstone, Ben</creatorcontrib><creatorcontrib>Neal, Richard D</creatorcontrib><creatorcontrib>Cooper, Matt</creatorcontrib><creatorcontrib>Jones, Monica</creatorcontrib><creatorcontrib>Pritchard-Jones, Kathy</creatorcontrib><creatorcontrib>Sullivan, Richard</creatorcontrib><creatorcontrib>Davie, Charlie</creatorcontrib><creatorcontrib>Lawler, Mark</creatorcontrib><creatorcontrib>Hemingway, Harry</creatorcontrib><collection>BMJ Open Access Journals</collection><collection>BMJ Journals:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>Coronavirus Research Database</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest Psychology</collection><collection>Nursing & Allied Health Premium</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>BMJ open</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lai, Alvina G</au><au>Pasea, Laura</au><au>Banerjee, Amitava</au><au>Hall, Geoff</au><au>Denaxas, Spiros</au><au>Chang, Wai Hoong</au><au>Katsoulis, Michail</au><au>Williams, Bryan</au><au>Pillay, Deenan</au><au>Noursadeghi, Mahdad</au><au>Linch, David</au><au>Hughes, Derralynn</au><au>Forster, Martin D</au><au>Turnbull, Clare</au><au>Fitzpatrick, Natalie K</au><au>Boyd, Kathryn</au><au>Foster, Graham R</au><au>Enver, Tariq</au><au>Nafilyan, Vahe</au><au>Humberstone, Ben</au><au>Neal, Richard D</au><au>Cooper, Matt</au><au>Jones, Monica</au><au>Pritchard-Jones, Kathy</au><au>Sullivan, Richard</au><au>Davie, Charlie</au><au>Lawler, Mark</au><au>Hemingway, Harry</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Estimated impact of the COVID-19 pandemic on cancer services and excess 1-year mortality in people with cancer and multimorbidity: near real-time data on cancer care, cancer deaths and a population-based cohort study</atitle><jtitle>BMJ open</jtitle><stitle>BMJ Open</stitle><addtitle>BMJ Open</addtitle><date>2020-11-17</date><risdate>2020</risdate><volume>10</volume><issue>11</issue><spage>e043828</spage><epage>e043828</epage><pages>e043828-e043828</pages><issn>2044-6055</issn><eissn>2044-6055</eissn><abstract>ObjectivesTo estimate the impact of the COVID-19 pandemic on cancer care services and overall (direct and indirect) excess deaths in people with cancer.MethodsWe employed near real-time weekly data on cancer care to determine the adverse effect of the pandemic on cancer services. We also used these data, together with national death registrations until June 2020 to model deaths, in excess of background (pre-COVID-19) mortality, in people with cancer. Background mortality risks for 24 cancers with and without COVID-19-relevant comorbidities were obtained from population-based primary care cohort (Clinical Practice Research Datalink) on 3 862 012 adults in England.ResultsDeclines in urgent referrals (median=−70.4%) and chemotherapy attendances (median=−41.5%) to a nadir (lowest point) in the pandemic were observed. By 31 May, these declines have only partially recovered; urgent referrals (median=−44.5%) and chemotherapy attendances (median=−31.2%). There were short-term excess death registrations for cancer (without COVID-19), with peak relative risk (RR) of 1.17 at week ending on 3 April. The peak RR for all-cause deaths was 2.1 from week ending on 17 April. Based on these findings and recent literature, we modelled 40% and 80% of cancer patients being affected by the pandemic in the long-term. At 40% affected, we estimated 1-year total (direct and indirect) excess deaths in people with cancer as between 7165 and 17 910, using RRs of 1.2 and 1.5, respectively, where 78% of excess deaths occured in patients with ≥1 comorbidity.ConclusionsDramatic reductions were detected in the demand for, and supply of, cancer services which have not fully recovered with lockdown easing. These may contribute, over a 1-year time horizon, to substantial excess mortality among people with cancer and multimorbidity. It is urgent to understand how the recovery of general practitioner, oncology and other hospital services might best mitigate these long-term excess mortality risks.</abstract><cop>England</cop><pub>British Medical Journal Publishing Group</pub><pmid>33203640</pmid><doi>10.1136/bmjopen-2020-043828</doi><orcidid>https://orcid.org/0000-0001-8960-8095</orcidid><orcidid>https://orcid.org/0000-0001-8741-3411</orcidid><orcidid>https://orcid.org/0000-0003-2279-0624</orcidid><orcidid>https://orcid.org/0000-0003-0160-217X</orcidid><orcidid>https://orcid.org/0000-0002-1734-5772</orcidid><orcidid>https://orcid.org/0000-0002-8094-1841</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 2044-6055 |
| ispartof | BMJ open, 2020-11, Vol.10 (11), p.e043828-e043828 |
| issn | 2044-6055 2044-6055 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7674020 |
| source | BMJ Open Access Journals; MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; PubMed Central Open Access |
| subjects | Adult Cancer Cause of Death - trends Chemotherapy Clinical medicine Cohort analysis Comorbidity Coronaviruses COVID-19 COVID-19 - epidemiology Electronic health records England - epidemiology Estimates Female Follow-Up Studies health informatics Health services Hospitals Humans Infections Lymphoma Male Medical diagnosis Medical screening Middle Aged Models, Statistical Mortality Multimorbidity - trends Neoplasms - epidemiology Oncology Pandemics Population Population Surveillance Population-based studies Practice research Primary care Public health SARS-CoV-2 Severe acute respiratory syndrome coronavirus 2 Survival Rate - trends Time Factors |
| title | Estimated impact of the COVID-19 pandemic on cancer services and excess 1-year mortality in people with cancer and multimorbidity: near real-time data on cancer care, cancer deaths and a population-based cohort study |
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