Modelling the Long-Term Effects of Covid-19 Cancer Services Disruption on Patient Outcome in Scotland
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Abstract
Background
Modelling the long-term effects of disruption of cancer services and minimising any excess cancer mortality due to the Covid-19 pandemic is of great importance. Here we adapted a stage-shift model to inform service planning decisions within NHS Scotland for the ‘‘Detect Cancer Early’ tumours, breast, colorectal and lung cancer which represent 46% of all cancers diagnosed in Scotland.
Methods & Data
Lung, colorectal and breast cancer incidence data for years 2017-18 were obtained from Public Health Scotland Cancer Quality Performance Indicators (QPI), to define a baseline scenario. The most current stage-specific 5-year survival data came from 2009-2014 national cancer registry and South East Scotland Cancer Network (SCAN) QPI audit datasets. The Degeling et al., inverse stage-shift model was adapted to estimate changes in stage at diagnosis, excess mortality and life-years lost from delays to diagnosis and treatment due to Covid-19-related health services disruption. Three and 6-month periods of disruption were simulated to demonstrate the model predictions.
Results
Approximately, 1-9% reductions in stage I/II presentations leading up to 2-10% increases in stage III/IV presentations are estimated across the three cancer types. A 6-month period of service disruption is predicted to lead to excess deaths at 5 years of 32.5 (31.1, 33.9) per 1000 cases for lung cancer, 16.5 (7.9, 24.3) for colorectal cancer and 31.6 (28.5, 34.4) for breast cancer.
Conclusions
Disruption of cancer diagnostic services can lead to significant excess deaths in following years. Increasing diagnostic and capacity for cancer services to deal with the backlog of care are needed. Real time monitoring of incidence and referral patterns over the disruption and post-disruption period to reduce excess deaths including more rapid incidence data by stage and other key tumour/clinical characteristics at presentation for key cancer cases (on a quarterly basis). Real time monitoring in cancer care and referral patterns should help inform what type of interventions are needed to reduce excess mortality and whether different population subgroups require public health messaging campaigns. Specific mitigation measures can be the subject of additional modelling analysis to assess the benefits and inform service planning decision making.
Article activity feed
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SciScore for 10.1101/2021.01.17.21249993: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your code and data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Limitations are these data represent early days and model assumptions on the time to treatment impact but future efforts with data will improve such modelling exercises for improved efforts to inform planning of cancer services. In conclusion, we endorse current efforts urging patients not to wait if they experience symptoms. The ‘Getting the right care in the right place’ campaign launched 14 July 2020 perhaps may have helped improve …
SciScore for 10.1101/2021.01.17.21249993: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your code and data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Limitations are these data represent early days and model assumptions on the time to treatment impact but future efforts with data will improve such modelling exercises for improved efforts to inform planning of cancer services. In conclusion, we endorse current efforts urging patients not to wait if they experience symptoms. The ‘Getting the right care in the right place’ campaign launched 14 July 2020 perhaps may have helped improve referrals and data to determine if indeed it did will be forthcoming. For now, making sure patients don’t delay in seeking help about symptoms of potential oncological significance and to get their cancers detected earlier when treatments and surgeries can be most effective.
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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