Elsevier

ESMO Open

Volume 6, Issue 3, June 2021, 100134
ESMO Open

Original Research
Delayed care for patients with newly diagnosed cancer due to COVID-19 and estimated impact on cancer mortality in France

https://doi.org/10.1016/j.esmoop.2021.100134Get rights and content
Under a Creative Commons license
open access

Highlights

  • A reduction of the number of cancer patients attending cancer centers was observed in France from January to July 2020.

  • This reduction was observed only for newly diagnosed patients.

  • The reduction of new diagnosis was more pronounced in women, for breast cancer, and prostate cancer, and nonmetastatic cancer.

  • No compensation was observed for the last months of 2020. The magnitude of delays may be larger in centers within the same country.

  • An estimation of the excess cancer death resulting from these delays is presented.

Background

The impact of the first coronavirus disease 2019 (COVID-19) wave on cancer patient management was measured within the nationwide network of the Unicancer comprehensive cancer centers in France.

Patients and methods

The number of patients diagnosed and treated within 17 of the 18 Unicancer centers was collected in 2020 and compared with that during the same periods between 2016 and 2019. Unicancer centers treat close to 20% of cancer patients in France yearly. The reduction in the number of patients attending the Unicancer centers was analyzed per regions and cancer types. The impact of delayed care on cancer-related deaths was calculated based on different hypotheses.

Results

A 6.8% decrease in patients managed within Unicancer in the first 7 months of 2020 versus 2019 was observed. This reduction reached 21% during April and May, and was not compensated in June and July, nor later until November 2020. This reduction was observed only for newly diagnosed patients, while the clinical activity for previously diagnosed patients increased by 4% similar to previous years. The reduction was more pronounced in women, in breast and prostate cancers, and for patients without metastasis. Using an estimated hazard ratio of 1.06 per month of delay in diagnosis and treatment of new patients, we calculated that the delays observed in the 5-month period from March to July 2020 may result in an excess mortality due to cancer of 1000-6000 patients in coming years.

Conclusions

In this study, the delays in cancer patient management were observed only for newly diagnosed patients, more frequently in women, for breast cancer, prostate cancer, and nonmetastatic cancers. These delays may result is an excess risk of cancer-related deaths in the coming years.

Key words

COVID-19
cancer
delay
diagnosis
treatment

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