November 4, 2020

expert reaction to study looking at delays in cancer treatment and risk of death

A systematic review and meta-analysis published in the BMJ looks at mortality due to cancer treatment delay.

Prof Clare Turnbull, Professor of Cancer Genomics at The Institute of Cancer Research, London, said:

“This work provides a comprehensive survey of all published studies examining outcomes in patients for whom their cancer treatment has been delayed, usefully examining chemotherapy, radiotherapy and surgery separately.

“These data are in agreement with our modelling studies of the impact of COVID-19-related disruption to cancer treatment, which suggest that systematic delays of a few months will over the forthcoming years result in substantial avoidable deaths across different cancer types.

“Timely diagnosis and treatment of cancer is key – and it is important to note that the benefit of reducing systematic delays in cancer pathways is greater than the survival benefit afforded by most emerging therapies.”

Prof Justin Stebbing, Professor of Cancer Medicine and Medical Oncology, Imperial College London, said:

“This is a very complex, evolving and difficult situation as we clearly need to protect vulnerable cancer patients from COVID-19.  I have recently published a paper in the Journal of the National Cancer Institute in over 3,000 hospitalised patients, showing that the fatality rate in hospitalised patients with COVID-19 and cancer was 23% compared to under 6% in hospitalised patients with COVID-19 alone in the patients included in our study¹.  We have to balance these sorts of risks against delays in treatment caused by the virus, all of which contributes to what is called excess mortality.  As we know, it’s not just the virus that can cause damage, but lockdowns and delays in routine care as well.

“This paper appropriately and accurately defines the effects of delays by different types of interventions such as surgery or systemic drug therapy, and in doing so can help us make the best decisions on behalf of each individual patient, because no two patients are the same.  They used lots of NHS data to make their conclusions which whilst not a randomised trial, are really helpful.  Just like my paper in the JNCI it includes data from lots of studies, a so-called meta-analysis and these are by their very nature robust analyses, especially if they include what we call individual patient data from other studies.  Not only do they find a 4 week delay being detrimental, but the longer the delay the worse it is.”

1 https://academic.oup.com/jnci/advance-article/doi/10.1093/jnci/djaa168/5951181

Dr Jodie Moffat, Cancer Research UK’s head of early diagnosis, said:

“Different cancers behave in different ways but for some, just a matter of weeks can be enough for the cancer to progress.  This is why swift diagnosis and treatment of cancer is so important.  Predicting the impact of treatment delays is very difficult to do because of all the different factors involved – this study didn’t take account of all the things that may have played a part so there is more to be unpicked.

“Worryingly, the latest England cancer waiting time data for August shows that targets for patients beginning treatment within 62 days of an urgent cancer referral are still being missed.  As health services are now having to manage a resurgence of Covid-19 on top of usual winter pressures, investment is urgently needed to make sure the NHS has the staff and equipment it needs to provide patients with life-saving diagnosis and treatment.”

Dr Lisa Wilde, Director of Research and External Affairs at Bowel Cancer UK, said:

“The COVID-19 crisis has led to many people with bowel cancer having their treatment delayed or cancelled.  Bowel cancer is the UK’s second biggest cancer killer in the UK, and we’re extremely concerned that we will see a further increase in deaths from the disease as a result of delays to treatment.

“But as the authors rightly acknowledge, while these delays can increase the risk of death, many other factors are also at play, including underlying health conditions patients may have.  This is not a ‘one size fits all’ issue and it’s essential that patients get the tailored treatment and support they need.

“We are desperate to ensure that bowel cancer patients do not become the forgotten casualties of COVID-19, and have called for assurances from all four nations of the UK that bowel cancer diagnostics and treatments will be preserved.”

‘Mortality due to cancer treatment delay: systematic review and meta-analysis’ by Hanna T P et al. was published in the BMJ at 23:30 UK time on Wednesday 4 November 2020.

DOI: 10.1136/bmj.m4087

Declared interests

Prof Justin Stebbing: “None.”

No others received.