Estimating excess mortality in people with cancer and multimorbidity in the COVID-19 emergency

The attached manuscript by a British group was embargoed until this morning. Appearing today on ResearchGate, this is a COVID-19 rapid communication, a preprint (Fred’s favorite kind, not peer-reviewed). Conclusions are that the COVID-19 emergency in England could result in at least 20% more deaths — over the next 12 months — in those who have been newly diagnosed with cancer. As these GEITP pages have mentioned before, while focusing on prevention of transmission of the virus, patients with underlying conditions are not receiving sufficient priority attention concerning their underlying serious medical conditions.

Authors [see attached preprint] used data from the health records (of more than 3.5 million patients in England). The study estimates that — pre-COVID-19 — ~31,354 newly diagnosed cancer patients would die within a year in England. As a result of this pandemic, authors estimate that there could be at least 6,270 additional deaths in newly diagnosed cancer patients alone, and this number could rise to an estimated 17,915 additional deaths if all people currently living with cancer are considered. The researchers analyzed recent weekly data from major cancer centers in the UK and found a 76% decrease in urgent referrals from general practitioners for people with suspected cancers and a 60% decrease in chemotherapy appointments for cancer patients, as compared to pre-COVID-19 levels.

The paper also models publicly available US data and shows an additional 33,890 deaths in the US in newly diagnosed cancer patients over the next year. The study estimates that pre-COVID-19, ~169,433 newly diagnosed cancer patients would die within a year in the US. The senior author added: “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 behavior in seeking medical attention, and the economic impact of COVID-19 — as well as deaths directly due to COVID-19 infection.”

Professor Mark Lawler said: “We applied our model to new cancers in the UK and the US, using publicly available data. The results are concerning. We believe countries need to rapidly understand how this pandemic is affecting cancer outcomes; otherwise, we risk adding cancer and other underlying health conditions to the escalating death toll of the COVID-19 pandemic.” This research provides a comprehensive picture of how patients living with a range of different cancers are affected by other (often treatable) long-term conditions — (including cardiovascular disease, hypertension, obesity and diabetes). Nearly eight out of ten of the additional deaths in people with cancer are estimated to occur in people with one or more of these long-term conditions.

The lead author stated: “Our findings demonstrate the serious potential for unintended consequences of the response to the COVID-19 pandemic, which may have a negative impact on patients with cancer and other underlying health conditions. It is vital that these patients are recognized as being vulnerable and their care is managed appropriately.” This research demonstrates the value to cancer patients, the wider public, and decision-makers —when trusted professionals use our patient data to help decide the best course of action. It also highlights the urgent need to be able to analyze these data quickly and accurately — to inform and influence current events.

DwN

ResearchGate 28 Apr 2020; Lai et al. | Excess deaths in cancer and multimorbidity | pp 1–10

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