Excess Cancer Deaths Research Articles

Impact of the COVID-19 Pandemic on Cancer Death Locations in Japan: An Analysis of Excess Mortality Through February 2023.

The novel coronavirus disease 2019 (COVID-19) pandemic has significantly impacted end-of-life decisions for cancer patients in Japan, with disparities existing between preferred and actual care settings. Our study investigates the potential shifts in cancer death locations during the pandemic and if there were excess cancer deaths. Utilizing national mortality data from the Ministry of Health, Labour and Welfare from January 2012 to February 2023, we identified cancer deaths using International Classification of Disease, 10th revision codes. We assessed death locations, including medical institutions, nursing facilities, and homes. The Farrington algorithm was employed to estimate expected death counts, and the differences between observed and expected counts were denoted as excess deaths. From January 2018 to February 2023, there was consistently increase in the weekly observed cancer deaths. The presence of a definitive excess during the pandemic period remains uncertain. The percentage of deaths in medical institutions declined from 83.3% to 70.1%, while home deaths increased from 12.1% to 22.9%. Between April 2020 and February 2023, deaths in medical institutions frequently fell below the 95% prediction lower limit. Home deaths consistently exceeded the 95% prediction upper limit, with significant excess deaths reported annually. Our study found a shift in cancer death locations from medical institutions to homes in Japan during the COVID-19 pandemic. Our study did not confirm an overall increase in cancer deaths during this period. As with global trends, the profound shift from hospitals to homes in Japan calls for a comprehensive exploration to grasp the pandemic's multifaceted impact on end-of-life cancer care decisions.

POCUS-first for nephrolithiasis: A Monte Carlo simulation illustrating cost savings, LOS reduction, and preventable radiation

ObjectivesNon-contrast computed tomography (NCCT) is the gold standard for nephrolithiasis evaluation in the emergency department (ED). However, Choosing Wisely guidelines recommend against ordering NCCT for patients with suspected nephrolithiasis who are <50 years old with a history of kidney stones. Our primary objective was to estimate the national annual cost savings from using a point-of-care ultrasound (POCUS)-first approach for patients with suspected nephrolithiasis meeting Choosing Wisely criteria. Our secondary objectives were to estimate reductions in ED length of stay (LOS) and preventable radiation exposure. MethodsWe created a Monte Carlo simulation using available estimates for the frequency of ED visits for nephrolithiasis and eligibility for a POCUS-first approach. The study population included all ED patients diagnosed with nephrolithiasis. Based on 1000 trials of our simulation, we estimated national cost savings in averted advanced imaging from this strategy. We applied the same model to estimate the reduction in ED LOS and preventable radiation exposure. ResultsUsing this model, we estimate a POCUS-first approach for evaluating nephrolithiasis meeting Choosing Wisely guidelines to save a mean (±SD) of $16.5 million (±$2.1 million) by avoiding 159,000 (±18,000) NCCT scans annually. This resulted in a national cumulative decrease of 166,000 (±165,000) annual bed-hours in ED LOS. Additionally, this resulted in a national cumulative reduction in radiation exposure of 1.9 million person-mSv, which could potentially prevent 232 (±81) excess cancer cases and 118 (±43) excess cancer deaths annually. ConclusionIf adopted widely, a POCUS-first approach for suspected nephrolithiasis in patients meeting Choosing Wisely criteria could yield significant national cost savings and a reduction in ED LOS and preventable radiation exposure. Further research is needed to explore the barriers to widespread adoption of this clinical workflow as well as the benefits of a POCUS-first approach in other patient populations.

Selected Articles from This Issue

During the COVID-19 pandemic, many colorectal cancer-related procedures were suspended, with unclear implications for colorectal cancer mortality. In this study, van den Puttelaar and colleagues used observed data and simulation modeling to estimate the impact on colorectal cancer outcomes, clinical resources, and associated tradeoffs, for longer versus shorter recovery periods to catch up procedures. The authors estimate that the disruptions may cause 4,200 to 14,400 excess colorectal cancer deaths in the US in the next 20 years, depending on the assumed extent of disruption, length of recovery period, and resources used. These estimates may help inform strategies to mitigate the broader impact of the COVID-19 pandemic or future crises.Christopher and colleagues used a data-driven approach to identify exercise trajectories over the adult life course and examined how these trajectories were associated with colon cancer risk within the NIH-AARP Diet and Health Study. Adults maintaining moderate-to-high amounts of exercise consistently throughout adulthood had a lower risk of colon cancer. Being inactive early in adulthood but increasing exercise participation by midlife was also suggestive of a lower risk. These findings are aligned with the current physical activity recommendations and add new evidence that promoting physical activity at all stages of the adult life course is needed for population-based colon cancer prevention.Few empirical data are available for older adults on the absolute risk of colorectal cancer and its associated mortality in the context of prior screening. Dalmat and colleagues address this evidence gap with estimates from a large population of screen-eligible adults ages 76 to 85 years who had a negative colonoscopy ten years ago. Estimates of cumulative incidence and mortality were 1.29% (95% CI: 1.02–1.61%) and 0.46% (95% CI: 0.30–0.70%), respectively, in eight years following screening eligibility date, after accounting for competing risk of death from another cause. Patients were approximately 90 times more likely to die from another cause than colorectal cancer, which may be an important context for older adults’ decision making.Nicotine metabolism significantly influences nicotine dependence. The goal of this study, by Perez-Paramo and colleagues, was to examine the impact of genetic variants in nicotine metabolizing enzyme genes on urinary levels of nicotine metabolites. Functional deficiency of cytochrome P450 2A6 caused multiple changes in nicotine metabolites in smokers’ urine. Genetic polymorphisms in multiple functional metabolizing enzyme genes showed a significant impact on urinary levels of many nicotine metabolites. These data suggest that multiple genes in several pathways are involved in the metabolism of nicotine, which may influence nicotine dependence and smoking behavior.

Comparison of Cancer Mortality and Incidence Between New Zealand and Australia and Reflection on Differences in Cancer Care: An Ecological Cross-Sectional Study of 2014-2018.

Despite many background similarities, New Zealand showed excess cancer deaths compared to Australia in previous studies. This study extends this comparison using the most recent data of 2014-2018. This study used publicly available cancer mortality and incidence data of New Zealand Ministry of Health and Australian Institute of Health and Welfare, and resident population data of Statistics New Zealand. Australian cancer mortality and incidence rates were applied to New Zealand population, by site of cancer, year, age and sex, to estimate the expected numbers, which were compared with the New Zealand observed numbers. For total cancers in 2014-2018, New Zealand had 780 excess deaths in women (17.1% of the annual total 4549; 95% confidence interval (CI) 15.8-18.4%), and 281 excess deaths in men (5.5% of the annual total 5105; 95% CI 4.3-6.7%) compared to Australia. The excess was contributed by many major cancers including colorectal, melanoma, and stomach cancer in both sexes; lung, uterine, and breast cancer in women, and prostate cancer in men. New Zealand's total cancer incidences were lower than those expected from Australia's in both women and men: average annual difference of 419 cases (-3.6% of the annual total 11505; 95% CI -4.5 to -2.8%), and 1485 (-11.7% of the annual total 12669; 95% CI -12.5 to -10.9%), respectively. Comparing time periods, the excesses in total cancer deaths in women were 15.1% in 2000-07, and 17.5% in 1996-1997; and in men 4.7% in 2000-2007 and 5.6% in 1996-1997. The differences by time period were non-significant. Excess mortality from all cancers combined and several common cancers in New Zealand, compared to Australia, persisted in 2014-2018, being similar to excesses in 2000-2007 and 1996-1997. It cannot be explained by differences in incidence, but may be attributable to various aspects of health systems governance and performance.

Excess mortality in patients with cancer during the COVID-19 pandemic in Peru: an analysis of death registry data

BackgroundThe COVID-19 pandemic has had a direct effect on patients with cancer, as reflected by the large number of COVID-19-related cancer deaths reported worldwide and the substantial decrease in cancer-related consultations during the pandemic. However, the impact of the COVID-19 pandemic on cancer mortality in Latin American countries has not been properly estimated. The aim of this study was to analyse the excess mortality related to cancer during the pandemic in Peru, including deaths directly or indirectly attributed to COVID-19.MethodsExcess mortality, which compares the number of deaths by any cause with the average number of expected deaths in typical circumstances during a specific timeframe, can be used as a simple but reliable indicator of the impact of the COVID-19 pandemic on cancer services. We carried out a descriptive study using data from the Peruvian death registration system, from which we filtered records that had registered neoplastic diseases (according to the tenth revision of WHO's International Statistical Classification of Diseases and Related Health Problems) as the cause of death between. Only data for the period of March 15 to June 30 in the years 2017–20 was included. We calculated excess mortality by subtracting the average number of deaths recorded for the indicated period between 2017 and 2019 from the same period of 2020 records (ie, the duration of lockdown measures in Peru) to obtain the percentage of excess mortality.FindingsThe percentage of changes in the number of cancer-related deaths in Peru was +13·90% from 2017 to 2018, –1·27% from 2018 to 2019, and +16·94% from 2019 to 2020. We found an excess mortality of 928 cases (corresponding to an excess mortality of +17·27%) among patients with cancer, when comparing years 2017–19 with the year 2020. During the lockdown in 2020, 3135 (58·4%) of 5372 cancer deaths happened at home (vs 5900 [44·2%] of 13 338 for the years 2017–19). The highest excess mortality percentage was observed in patients with prostate cancer (+50·43%), breast cancer (+33·62%), and leukaemia (32·78%). Although these findings appear to be in line with reports from other countries, only 184 (3·4%) of 5372 deaths were registered with COVID-19 as an additional cause of death.InterpretationOur results suggest that COVID-19 control measures (eg, lockdowns, physical distancing, and isolation of symptomatic patients), alongside the overwhelming strain on the health-care system, had a detrimental impact on cancer mortality in Peru. The pandemic has exposed flaws in the Peruvian health-care system, especially regarding cancer care. Although we recognise that the rate of COVID-19 testing in Peru is one of the lowest in Latin America, the excess of cancer deaths cannot be fully explained by COVID-19. These findings might be an indication that the alarming increase in cancer mortality in Peru could continue over the upcoming months if no action is taken. Our study also shows the importance of an adequate registry of deaths. We recommend that the national authorities should implement policies to limit the impact of the COVID-19 pandemic on patients with cancer, and that the continuous update and monitoring of deaths initiated during the COVID-19 pandemic is sustained. These measures can help to confirm the increasing trend in cancer deaths; serve as a rationale to develop strategies that can alleviate this burden (eg, by adopting models for delivering optimal cancer care while minimising transmission of COVID-19); and minimise the possibility of an increase in patients presenting with advanced-stage cancers.FundingInternational Joint Laboratories Programme of the French National Research Institute for Sustainable Development.

The impact of COVID-19 on screening for colorectal, gastric, breast, and cervical cancer in Korea.

The coronavirus disease 2019 (COVID-19) pandemic has affected the utilization of healthcare services, including participation in cancer screening programs. We compared cancer screening participation rates for colorectal, gastric, breast, and cervical cancers among participants in the National Cancer Screening Program (NCSP) in 2019 and 2020 to address the potential distraction effect of COVID-19 on cancer screening. Data from the NCSP for 4 cancer types (stomach, colorectal, breast, and cervical) in 2019 and 2020 were used to calculate cancer screening participation rates by calendar month, gender, age group, and geographical region. Monthly participation rates were analyzed per 1,000 eligible individuals. The screening participation rate decreased in 2020 compared to 2019 for all 4 cancers: colorectal (40.5 vs. 35.3%), gastric (61.9 vs. 54.6%), breast (63.8 vs. 55.8%), and cervical (57.8 vs. 52.2%) cancers. Following 2 major COVID-19 waves in March and December 2020, the participation rates in the 4 types of cancer screening dropped compared with those in 2019. The highest decline was observed in the elderly population aged 80 years and older (percentage change: -21% for colorectal cancer; -20% for gastric cancer; -26% for breast cancer; -20% for cervical cancer). After the 2 major COVID-19 waves, the screening participation rate for 4 types of cancer declined compared with 2019. Further studies are needed to identify the indirect effects of the COVID-19 pandemic on cancer patients, such as delayed diagnoses of cancer or excess cancer deaths.

Cancer incidence and mortality in Australia from 2020 to 2044 and an exploratory analysis of the potential effect of treatment delays during the COVID-19 pandemic: a statistical modelling study

SummaryBackgroundLong-term projections of cancer incidence and mortality estimate the future burden of cancer in a population, and can be of great use in informing the planning of health services and the management of resources. We aimed to estimate incidence and mortality rates and numbers of new cases and deaths up until 2044 for all cancers combined and for 21 individual cancer types in Australia. We also illustrate the potential effect of treatment delays due to the COVID-19 pandemic on future colorectal cancer mortality rates.MethodsIn this statistical modelling study, cancer incidence and mortality rates in Australia from 2020 to 2044 were projected based on data up to 2017 and 2019, respectively. Cigarette smoking exposure (1945–2019), participation rates in the breast cancer screening programme (1996–2019), and prostate-specific antigen testing rates (1994–2020) were included where relevant. The baseline projection model using an age-period-cohort model or generalised linear model for each cancer type was selected based on model fit statistics and validation with pre-COVID-19 observed data. To assess the impact of treatment delays during the COVID-19 pandemic on colorectal cancer mortality, we obtained data on incidence, survival, prevalence, and cancer treatment for colorectal cancer from different authorities. The relative risks of death due to system-caused treatment delays were derived from a published systematic review. Numbers of excess colorectal cancer deaths were estimated using the relative risk of death per week of treatment delay and different durations of delay under a number of hypothetical scenarios.FindingsProjections indicate that in the absence of the COVID-19 pandemic effects, the age-standardised incidence rate for all cancers combined for males would decline over 2020–44, and for females the incidence rate would be relatively stable in Australia. The mortality rates for all cancers combined for both males and females are expected to continuously decline during 2020–44. The total number of new cases are projected to increase by 47·4% (95% uncertainty interval [UI] 35·2–61·3) for males, from 380 306 in 2015–19 to 560 744 (95% UI 514 244–613 356) in 2040–44, and by 54·4% (95% UI 40·2–70·5) for females, from 313 263 in 2015–19 to 483 527 (95% UI 439 069–534 090) in 2040–44. The number of cancer deaths are projected to increase by 36·4% (95% UI 15·3–63·9) for males, from 132 440 in 2015–19 to 180 663 (95% UI 152 719–217 126) in 2040–44, and by 36·6% (95% UI 15·8–64·1) for females, from 102 103 in 2015–19 to 139 482 (95% UI 118 186–167 527) in 2040–44, due to population ageing and growth. The example COVID-19 pandemic scenario of a 6-month health-care system disruption with 16-week treatment delays for colorectal cancer patients could result in 460 (95% UI 338–595) additional deaths and 437 (95% UI 314–570) deaths occurring earlier than expected in 2020–44.InterpretationThese projections can inform health service planning for cancer care and treatment in Australia. Despite the continuous decline in cancer mortality rates, and the decline or plateau in incidence rates, our projections suggest an overall 51% increase in the number of new cancer cases and a 36% increase in the number of cancer deaths over the 25-year projection period. This means that continued efforts to increase screening uptake and to control risk factors, including smoking exposure, obesity, physical inactivity, alcohol use, and infections, must remain public health priorities.FundingPartly funded by Cancer Council Australia.

Modelling the Potential Impact of Weight Gain During the COVID-19 Pandemic on the Future Burden of Cancer

ObjectivesTo understand potential long-term consequences of the impacts of the COVID-19 pandemic and resulting public health measures on daily life, specifically shifts in health behaviours which contribute to weight gain. MethodsData on unintentional weight gain among adults during the first year of the COVID-19 pandemic was applied to national survey data to simulate pre and post weight gain body mass index (BMI). Population impact measures were estimated using OncoSim, a web-based microsimulation tool, which simulates the trajectory of cancer, calibrated using Canadian cancer incidence and mortality data along with measurable risk for specified cancers from lifestyle risk factors. Projections were estimated until 2042, assuming a 12-year latency period. ResultsFollowing a mean weight gain of 11.4 lbs, the proportion of underweight, overweight, obese and morbidly obese BMI were: 37%, 36%, 18% and 9%, respectively. The projected excess cancer cases would reach 8,651 and 16,915 by 2037 and 2042. The additional cancer burden will disproportionately impact women. The largest projected increases were observed for uterine, kidney and liver cancers among women, with mean potential impact fractions (PIF) of 4.26%, 2.58% and 2.08%, respectively. Among men, the largest mean PIFs were observed for esophageal (3.03%), kidney (2.28%) and liver (1.81%) cancers. The projected excess cancer deaths would reach 6,254 by 2042, with the largest burden projected for colorectal, esophageal and pancreatic cancer (N = 1,087, N = 945, and N = 813). ConclusionsThese projections highlight the possible long-term consequences of changes in health behavior during the COVID-19 pandemic on the burden of cancer in Canada. This underscores the critical need for timely investment into effective cancer prevention strategies, to minimize the likelihood that unhealthy lifestyle changes during the COVID-19 pandemic are sustained. Funding SourcesMichael Smith Foundation for Health Research, the Canadian Partnership Against Cancer, Health Canada.

Impact of the COVID-19 pandemic on cancer incidence and mortality

Impact of the COVID-19 pandemic on cancer incidence and mortality

Projected Impact of Weight Gain During the COVID-19 Pandemic on the Future Burden of Cancer in Canada

The COVID-19 pandemic and resulting public health measures have had significant impacts on daily life, including shifts in health behaviours which contribute to weight gain and may increase subsequent risk of chronic diseases such as cancer. Using OncoSim, a web-based microsimulation tool, we estimated the future burden of cancer in Canada by incorporating data on unintentional weight gain among adults during the first year of the COVID-19 pandemic. Population impact measures were estimated until 2042, assuming a 12-year latency period. We estimated 14,194 excess cancer cases and 5,324 excess cancer deaths by 2042 due to COVID-19 related weight gain. Particularly large impacts were estimated for endometrial and breast cancer among women, with 2,983 and 2,151 excess cases by 2042. For men, 1,700 excess colorectal cases and 1,188 excess kidney cancer cases were projected by 2042. Changes in health behavior during the COVID-19 pandemic are likely to have significant and long-lasting impacts on cancer burden. These projections highlight the immediate need for investment into the development and implementation of effective cancer prevention strategies.

189: THE EFFECT OF COVID -19 ON THE NEW DIAGNOSIS OF ESOPHAGOGASTRIC CANCER IN THE UK: A SINGLE-CENTRE EXPERIENCE

Abstract Background and aim Covid-19 has had a devastating global impact and resulted in over 4.4 million directly attributed deaths. The UK entered lockdown in March 2020, redistributing its medical workforce and resources. Early estimations suggested at least 4700 extra cancer deaths at 5 years if there was a 3-month delay to surgery. Delays to diagnosis and treatment for esophagogastric (EG) cancers can be particularly detrimental to survival. The aim of this study is to assess the impact of Covid-19 on new cancer referrals to a centralised UK EG cancer centre, including presentation, decision making and treatment. Methods Patients with EG cancer referred to a tertiary, high-volume centre between March 2019 and March 2021 were reviewed. Patients were stratified into Pre-covid (March 2019–March 2020) and Covid (March 2020–2021) cohorts. Number of new referrals, clinical stage, treatment decision, and time to treatment were compared for gastric adenocarcinoma (GA), esophagogastric-junction adenocarcinoma (EGJA), esophageal adenocarcinoma (EA) and esophageal SCC (ESCC). Results There was an 11% reduction in new cancer referrals (485 vs 431). GA, EGJA and EA did not have significant change in treatment intent, although there was a significant increase in the decision for definitive non-surgical treatment of EA (P = 0.046). GA and EA patients had a small, but significant increase in average clinical stage at presentation (P &amp;lt; 0.05). There was no increase in time to treatment for GA, EGJA and EA. A significantly higher proportion of ESCC patients were given curative intent treatment in the Covid-19 cohort (P = 0.0006) however, this was accompanied with an increased time to treatment (35.8 days vs 27.9 days P = 0.0198). Conclusion This high-volume centre has seen a reduction in new cancer referrals since the first UK lockdown. This was associated with a small, but significant, increase in clinical stage of GA and EA at presentation. This may represent an early indication of excess esophagogastric cancer deaths due to the impact of Covid-19. This data also confirms initial results showing that oncological decisions were not compromised, although Covid-19 remains a dynamic challenge.

The impact of COVID-19 in breast cancer diagnosis: a casuistic from our center

Background: The COVID-19 pandemic has posed significant pressures on healthcare system resources and treatment decisions at the provider and patient level. Regarding breast imaging, several articles demonstrated sizable decreases in imaging volumes, particularly in mammography examinations, due to lockdown recommendations by governments, concerns of patients for the potential virus exposure at hospitals and delaying non-mandatory screening examinations in most facilities. So, how did the COVID-19 affect our center? Materials and Methods: We performed a retrospective study, comparing the group of patients admitted in our hospital with breast cancer diagnosis, older than 18 years, between march and december 2019, with the same group of patients admitted between march and december of 2020.We analyzed the data regarding time periods between the first appointment and the different imaging tests. Results: 212 patients were included in our study, 122 from 2019 and 90 from 2020, and 135 patients excluded.The time between the first appointment and the biopsy increased 27.6 days from 2019 to 2020. Conversely, there was a reduction of the time between the biopsy and the anatomopathological result (13.3 days).As for the different imaging tests, we reported an increase from the first appointment to axillary ultrasound, MRI, and bone scintigraphy, in 11.9, 20.2 and 25.2 days, respectively. Conclusions: As we would expect, we observed a delayed response from the imageology department during the pandemic period. This was probably due to a redistribution of human and technical resources, which resulted in less availability for elective exams.On the other hand, the anatomopathological response was faster during this period, perhaps associated with a decrease in work volume, directly related to a reduction in elective surgeries and benign pathologies.The COVID-19 pandemic significantly affected the healthcare system resources, as we can confirm with this study. However, the true impact is yet to be seen, with delays in screening and diagnosis, which will probably result in thousands of excess cancer deaths over the next several years.

P-OGC80 The effect of COVID -19 on new diagnosis oesophagogastric cancer patients in the UK: A single-centre experience

BackgroundCovid-19 has had a devastating global impact and resulted in over 4.4 million directly attributed deaths. The UK entered lockdown in March 2020, redistributing its medical workforce and resources. Early estimations suggested at least 4700 extra cancer deaths at 5 years if there was a 3-month delay to surgery. Delays to diagnosis and treatment for osophagogastric (OG) cancers can be particularly detrimental to survival. The aim of this study is to assess the impact of Covid-19 on new cancer referrals to a centralised UK OG cancer centre, including presentation, decision making and treatment. MethodsPatients with OG cancer referred to a tertiary, high-volume centre between March 2019 and March 2021 were reviewed. Patients were stratified into Pre-covid (March 2019-March 2020) and Covid (March 2020-2021) cohorts. Number of new referrals, clinical stage, treatment decision, and time to treatment were compared for gastric adenocarcinoma (GA), oesophagogastric-junction adenocarcinoma (OGJA), oesophageal adenocarcinoma (OA) and oesophageal SCC (OSCC).ResultsThere was an 11% reduction in new cancer referrals (485 vs 431). GA, OGJA and OA did not have significant change in treatment intent, although there was a significant increase in the decision for definitive non-surgical treatment of OA (P = 0.046). GA and OA patients had a small, but significant increase in mean clinical stage at presentation (P < 0.05). There was no increase in time to treatment for GA, OGJA and OA. A significantly higher proportion of OSCC patients were given curative intent treatment in the Covid-19 cohort (P = 0.0006) however, this was accompanied with an increased time to treatment commencement (35.8 days vs 27.9 days P = 0.0198). ConclusionsThis high-volume centre has seen a reduction in new cancer referrals since the first UK lockdown. This was associated with a small, but significant, increase in clinical stage of GA and OA at presentation. This may represent an early indication of excess oesophagogastric cancer deaths due to the impact of Covid-19. This data also confirms initial results showing that oncological decisions were not compromised, although Covid-19 remains a dynamic challenge.

Predicted long-term impact of COVID-19 pandemic-related care delays on cancer mortality in Canada.

The COVID‐19 pandemic has affected cancer care worldwide. This study aimed to estimate the long‐term impacts of cancer care disruptions on cancer mortality in Canada using a microsimulation model. The model simulates cancer incidence and survival using cancer incidence, stage at diagnosis and survival data from the Canadian Cancer Registry. We modeled reported declines in cancer diagnoses and treatments recorded in provincial administrative datasets in March 2020 to June 2021. Based on the literature, we assumed that diagnostic and treatment delays lead to a 6% higher rate of cancer death per 4‐week delay. After June 2021, we assessed scenarios where cancer treatment capacity returned to prepandemic levels, or to 10% higher or lower than prepandemic levels. Results are the median predictions of 10 stochastic simulations. The model predicts that cancer care disruptions during the COVID‐19 pandemic could lead to 21 247 (2.0%) more cancer deaths in Canada in 2020 to 2030, assuming treatment capacity is recovered to 2019 prepandemic levels in 2021. This represents 355 172 life years lost expected due to pandemic‐related diagnostic and treatment delays. The largest number of expected excess cancer deaths was predicted for breast, lung and colorectal cancers, and in the provinces of Ontario, Québec and British Columbia. Diagnostic and treatment capacity in 2021 onward highly influenced the number of cancer deaths over the next decade. Cancer care disruptions during the COVID‐19 pandemic could lead to significant life loss; however, most of these could be mitigated by increasing diagnostic and treatment capacity in the short‐term to address the service backlog.

Measuring health-related social deprivation in small areas: development of an index and examination of its association with cancer mortality

BackgroundThe small-area deprivation indices are varied across countries due to different social context and data availability. Due to lack of chronic disease-related social deprivation index (SDI) in Hong Kong, China, this study aimed to develop a new SDI and examine its association with cancer mortality.MethodsA total of 14 socio-economic variables of 154 large Tertiary Planning Unit groups (LTPUGs) in Hong Kong were obtained from 2016 population by-census. LTPUG-specific all-cause and chronic condition-related mortality and chronic condition inpatient episodes were calculated as health outcomes. Association of socio-economic variables with health outcomes was estimated for variable selection. Candidates for SDI were constructed with selected socio-economic variables and tested for criterion validity using health outcomes. Ecological association between the selected SDI and cancer mortality were examined using zero-inflated negative binomial regression.ResultsA chronic disease-related SDI constructed by six area-level socio-economic variables was selected based on its criterion validity with health outcomes in Hong Kong. It was found that social deprivation was associated with higher cancer mortality during 2011–2016 (most deprived areas: incidence relative risk [IRR] = 1.40, 95% confidence interval [CI]: 1.27–1.55; second most deprived areas: IRR = 1.34, 95%CI: 1.21–1.48; least deprived areas as reference), and the cancer mortality gap became larger in more recent years. Excess cancer death related to social deprivation was found to have increased through 2011–2016.ConclusionsOur newly developed SDI is a valid and routinely available measurement of social deprivation in small areas and is useful in resource allocation and policy-making for public health purpose in communities. There is a potential large improvement in cancer mortality by offering relevant policies and interventions to reduce health-related deprivation. Further studies can be done to design strategies to reduce the expanding health inequalities between more and less deprived areas.

Estimating the impact of the COVID-19 pandemic on diagnosis and survival of five cancers in Chile from 2020 to 2030: a simulation-based analysis.

BackgroundThe COVID-19 pandemic has strained health system capacity worldwide due to a surge of hospital admissions, while mitigation measures have simultaneously reduced patients' access to health care, affecting the diagnosis and treatment of other diseases such as cancer. We estimated the impact of delayed diagnosis on cancer outcomes in Chile using a novel modelling approach to inform policies and planning to mitigate the forthcoming cancer-related health impacts of the pandemic in Chile.MethodsWe developed a microsimulation model of five cancers in Chile (breast, cervix, colorectal, prostate, and stomach) for which reliable data were available, which simulates cancer incidence and progression in a nationally representative virtual population, as well as stage-specific cancer detection and survival probabilities. We calibrated the model to empirical data on monthly detected cases, as well as stage at diagnosis and 5-year net survival. We accounted for the impact of COVID-19 on excess mortality and cancer detection by month during the pandemic, and projected diagnosed cancer cases and outcomes of stage at diagnosis and survival up to 2030. For comparison, we simulated a no COVID-19 scenario in which the impacts of COVID-19 on excess mortality and cancer detection were removed.FindingsOur modelling showed a sharp decrease in the number of diagnosed cancer cases during the COVID-19 pandemic, with a large projected short-term increase in future diagnosed cases. Due to the projected backlog in diagnosis, we estimated that in 2021 there will be an extra 3198 cases (95% uncertainty interval [UI] 1356–5017) diagnosed among the five modelled cancers, an increase of nearly 14% compared with the no COVID-19 scenario, falling to a projected 10% increase in 2022 with 2674 extra cases (1318–4032) diagnosed. As a result of delayed diagnosis, we found a worse stage distribution for detected cancers in 2020–22, which is estimated to lead to 3542 excess cancer deaths (95% UI 2236–4816) in 2022–30, compared with the no COVID-19 scenario, among the five modelled cancers, most of which (3299 deaths, 2151–4431) are projected to occur before 2025.InterpretationIn addition to a large projected surge in diagnosed cancer cases, we found that delays in diagnosis will result in worse cancer stage at presentation, leading to worse survival outcomes. These findings can help to inform surge capacity planning and highlight the importance of ensuring appropriate health system capacity levels to detect and care for the increased cancer cases in the coming years, while maintaining the timeliness and quality of cancer care. Potential delays in treatment and adverse impacts on quality of care, which were not considered in this model, are likely to contribute to even more excess deaths from cancer than projected.FundingHarvard TH Chan School of Public Health.TranslationsFor the Spanish and Portuguese translations of the abstract see Supplementary Materials section.

Misreported Cancer Deaths in PLATO Trial.

The potential link between antiplatelet agents and anticoagulants with excess cancer deaths (CD) was reported first for prasugrel (TRITON, DAPT), clopidogrel (DAPT), vorapaxar (TRACER), apixaban (APPRAISE-2), and later ticagrelor (PEGASUS). However, verified CD in the ticagrelor indication-seeking PLATO were not public. We obtained the complete list of deaths and their primary causes in PLATO, matched that dataset against local site records, and analyzed the patterns of CD reporting. The FDA-issued spreadsheet contains 31 precisely detailed CD (PLATO code 12-3). We obtained local site evidence for four CD and matched them with FDA-reported. We also assessed the patterns of how CD were reported among non-vascular death database column “S” by scrolling the FDA Excel file down among 938 PLATO entries. Clopidogrel CD (n = 17) were reported exclusively by sponsor, while independent CRO’s reported only ticagrelor CD (3 out of 14 PLATO total). Among four matched verified outcomes, one ticagrelor CD was correct, second ticagrelor CD was unreported, and two (ticagrelor and clopidogrel) CD were reported inaccurately. Of the remaining 16 clopidogrel CD six were reported as three separate next in line paired entries in Denmark (236–237), Poland (597–598), Romania (679–680), and as two more fatalities in South Africa (786) and Spain (789), while patients 787 and 788 received ticagrelor out of 938 records suggesting possible late addition of incorrect clopidogrel CD reports. We conclude that some CD were misreported in PLATO, favoring ticagrelor. Such mismatch may require reevaluation of this critical outcome in the trial focusing on the exact death cause reported by site investigators.

Impact of the COVID-19 Pandemic on Breast Cancer Mortality in the US: Estimates From Collaborative Simulation Modeling.

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has disrupted breast cancer control through short-term declines in screening and delays in diagnosis and treatments. We projected the impact of COVID-19 on future breast cancer mortality between 2020 and 2030. MethodsThree established Cancer Intervention and Surveillance Modeling Network breast cancer models modeled reductions in mammography screening use, delays in symptomatic cancer diagnosis, and reduced use of chemotherapy for women with early-stage disease for the first 6 months of the pandemic with return to prepandemic patterns after that time. Sensitivity analyses were performed to determine the effect of key model parameters, including the duration of the pandemic impact.ResultsBy 2030, the models project 950 (model range = 860-1297) cumulative excess breast cancer deaths related to reduced screening, 1314 (model range = 266-1325) associated with delayed diagnosis of symptomatic cases, and 151 (model range = 146-207) associated with reduced chemotherapy use in women with hormone positive, early-stage cancer. Jointly, 2487 (model range = 1713-2575) excess breast cancer deaths were estimated, representing a 0.52% (model range = 0.36%-0.56%) cumulative increase over breast cancer deaths expected by 2030 in the absence of the pandemic’s disruptions. Sensitivity analyses indicated that the breast cancer mortality impact would be approximately double if the modeled pandemic effects on screening, symptomatic diagnosis, and chemotherapy extended for 12 months.ConclusionsInitial pandemic-related disruptions in breast cancer care will have a small long-term cumulative impact on breast cancer mortality. Continued efforts to ensure prompt return to screening and minimize delays in evaluation of symptomatic women can largely mitigate the effects of the initial pandemic-associated disruptions.

Dying from cancer with COVID-19: age, sex, socio-economic status, and comorbidities

Background The COVID-19 pandemic has caused excess deaths (all causes) and has disproportionately affected the elderly with certain characteristics. Objectives To study how COVID-19 affected cancer deaths regarding age, sex, socio-economic status, comorbidities, and access to palliative care. An additional objective was to study changes in place of care and death. Material and methods A descriptive, retrospective study of all cancer patients who died during March–May 2020 in the Stockholm region, n = 1467 of which 278 died with a COVID-19 diagnosis, compared with deaths in 2016–2019. The Stockholm Regional Council’s central data warehouse was used. T-tests, 95% CI, Wilcoxon and chi-squared tests were used for comparisons. Results There were excess cancer deaths compared with 2016–2019 (p < 0.001) and patients dying with a COVID-19 diagnosis were older (79.7 vs. 75.9 years, p < 0.0001), more often male (67% vs. 55%, p < 0.0001), and had more comorbidities (Charlson Comorbidity Index 1.6 vs. 1.1, p < 0.0001). Patients with COVID-19 more seldom had access to palliative care (34% vs. 59%, p = 0.008), had more changes in place of care during the last two weeks of life (p < 0.0001) and died more often in acute hospitals (34% vs. 14%, p < 0.0001). For the subgroup with access to palliative care, the hospital deaths for individuals with and without a COVID-19 diagnosis were 11% and 4%, respectively (p = 0.008). Conclusion Cancer patients dying with a COVID-19 diagnosis were older, more often male, and had more comorbidities. A COVID-19 diagnosis negatively affected the probability of being admitted to specialized palliative care and increased the likelihood of dying in an acute hospital.

Landscape of COVID-19 vaccine uptake in the colorectal cancer community: Responding to community needs.

e15577 Background: The novel coronavirus (COVID-19) has caused numerous disruptions across the cancer prevention and treatment landscape. A model released by the National Cancer Institute (NCI) predicts that delays in care will cause 10,000 excess breast and colorectal cancer deaths over the next 10 years due to the pandemic. Vaccines will play an integral role in colorectal cancer patients and their support systems to return to care and resume ‘normal activities’; but based on anecdotal reports from the oncology and prevention community, there are questions about patients’ willingness to receive vaccines when available. The goal of this analysis was to better understand general uptake of vaccines at various time points, intention to vaccinate when available and what questions and concerns patients have about getting a vaccine. Methods: In January, 2021 Fight Colorectal Cancer (Fight CRC) distributed an online survey to the colorectal cancer community asking about vaccine related questions. The survey was a convenience sample approach distributed through social media channels and targeted emails from mid-January to early February 2021. Virtual focus groups and repeat surveys will be administered in spring of 2021 to further gather detail about the uptake of the vaccine, including barriers and facilitators to care. Results: In total, 201 individuals responded to the survey (survivor = 77%, family member = 11%, caregiver/friend = 8% other = 3%). The colorectal cancer patient sample was composed mostly of later stage patients (stage III and IV = 77%). Approximately 30% of patients reported vaccine uptake, 81% noted they would likely get vaccinated when a vaccine became available to them. Of all the patients, 16% noted they would need more information about the vaccine before deciding if they would be vaccinated. The majority indicated needing tips to discuss receiving the vaccine with their doctor, including impact on treatment, and the top questions patients have are: 1) Is the vaccine safe? 2) Will the vaccine interrupt my cancer treatment care? Conclusions: People with cancer face unique challenges since the pandemic, including treatment disruptions. Even with a vaccine, not all patients have access or are convinced they will receive the vaccine when it becomes available to them. Understanding patient needs and how to respond to ensure patients receive the most credible information to make informed decisions is critical.