The aftereffects of the UK national lockdown – could the reduction in urgent referrals, diagnostic and surgical capacities result in increased cancer morbidity and mortality?

Abstract

Background: The COVID-19 pandemic has cause major disruption to daily life in the United Kingdom in 2020. The national lockdown and mobilization of healthcare resources to areas with increased demand has resulted in a historical shift in referral, diagnostic and surgical capabilities in most healthboards. This regional, retrospective study aimed to shed light on the potential consequences of the UK national lockdown, the resultant decrease in referrals and diagnostic capacity on surgical services and patients during the recovery phase. Methods: Urgent referrals for suspected (USC) prostate cancer ( N =1430) from primary care in the north-east of Scotland and the number of diagnostic prostate biopsies performed in the region were reviewed to assess trends between January 2018 and December 2020. The data was anonymized and charted to highlight the differences between the period of national lockdown and other times. Results: The number of USC referrals for prostate cancer dropped significantly between March 2020 and June 2020 (a mean of 25 per month from 45 per month in the same period in 2018 and 2019). The number of diagnostic procedures also decreased significantly, with 74 fewer biopsies having been performed during the lockdown period compared with the same period in 2019. Conclusions: The shifts in USC referrals and diagnostics during the lockdown period have led to a backlog which may put patients at risk of cancer stage migration, leading to increased morbidity and mortality. This study indicates that reestablishment of surgical services should take priority during the recovery phase. Level of evidence: 3