Published on January 27, 2021
The Cost of Delaying Cancer Treatment During COVID-19
Delaying cancer treatment for just four weeks is associated with a higher risk of dying, according to a review of 34 studies published in The British Medical Journal.
And the longer treatment is delayed, the higher the risk. The findings, which involved more than 1.2 million patients collectively, apply across surgery, systemic treatment (e.g., chemotherapy, hormonal therapy, targeted drugs and immunotherapy) and radiotherapy.
For surgery, there is a 6% to 8% increase in the risk of death for every four-week delay, the researchers found. The risk was even higher for some radiotherapy and systemic treatments: 9% increased risk of death for head and neck radiotherapy and 13% for adjuvant (follow-up) systemic treatment for colorectal cancer.
“We acknowledge that treatment delays are multifactorial in cause and that patients should not start treatment before they are medically fit to do so, and have completed all appropriate evaluations,” the authors wrote. “However, these data strongly support efforts to minimize system-level delays.”
The results are particularly relevant during the COVID-19 pandemic. Federal and state governments as well as other organizations, such as the American College of Surgeons, pushed hospitals to limit non-essential elective surgeries and procedures until further notice in response to the surge of patients with COVID-19. Cancer patients across the country reported having chemotherapy delayed or surgery canceled.
What to Do If Your Cancer Treatment is Delayed
- Find out why. For example, if your surgery was postponed because the hospital had an influx of patients with COVID-19, you may be able to have the procedure done somewhere else.
- Talk to your healthcare team about the potential risks involved. Team members should be able to address your concerns.
- Ask whether your treatment can be continued at home, such as switching from IV chemo to oral chemo.
- Consider a telehealth consultation with another healthcare provider. He or she should be able to review your medical records, discuss your case with you, and either confirm the delay is prudent or recommend another course of action.
Note: Tips adapted from Cancer Treatment Centers of America.
“Many countries have experienced deferral of elective cancer surgery and radiotherapy, and reductions in the use of systemic treatments because systems have reassigned healthcare resources to pandemic preparedness,” the authors wrote. “The lack of high-quality data on the impact of deferred and delayed cancer treatment has meant that the impact of COVID-19 lockdown measures on patterns of care and subsequent outcomes has not been robustly quantified.”
The researchers used an example from the UK's National Health Service (NHS) which, at the beginning of the COVID-19 pandemic, created an algorithm to prioritize surgery. Several conditions had been considered safe to delay treatment by 10 to 12 weeks with no predicted impact on the outcome, including all colorectal surgery. Increasing the wait to surgery from six weeks to 12 weeks would increase the risk of death in this setting by 9%, the authors said.
Researchers investigated seven cancers that together represent 44% of all cancers globally: five common cancers (bladder, breast, colon, rectum, lung), cervical cancer and head and neck cancer, for which there is an established association between treatment delay and mortality.
Treatment delay was defined as the time from diagnosis to treatment for the first treatment (surgery or radiation), and from the time of surgery to treatment for adjuvant indications (chemotherapy or radiation after surgery).
Investigators found a linear relationship between treatment delays and the risk of death. An eight-week delay in breast cancer surgery would increase the risk of death by 17%, while a 12-week delay increased the risk by 26%, they reported.
These delays could translate into significant excess deaths, the researchers said. A surgical delay of 12 weeks for all patients with breast cancer for a year (e.g., during COVID-19 lockdown and recovery) would lead to 1,400 excess deaths in the United Kingdom, 6,100 in the United States, 700 in Canada, and 500 in Australia, assuming surgery was the first treatment in 83% of the cases.
Furthermore, the investigators note that the results do not take into account the impact of a delay in treatment on functional outcomes (e.g., continence, swallowing), complications from more extensive treatments because of progression during delays, and a decrease in quality of life. Also of consideration is the greater economic burden due to higher direct care costs and productivity losses because of premature mortality and morbidity.
“Taken as a whole, these results suggest there is an urgent need to reconsider how we organize our cancer services,” the researchers wrote. “The prevailing paradigm has been around access to new treatments to improve outcomes, but from a system level, gains in survival might be achieved by prioritizing efforts to minimize the time from cancer diagnosis to initiation of treatment from weeks to days.”
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