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. 2022 Apr 15;150(8):1244-1254.
doi: 10.1002/ijc.33884. Epub 2021 Dec 3.

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

Talía Malagón  1   2 , Jean H E Yong  3 , Parker Tope  1 , Wilson H Miller Jr  2 , Eduardo L Franco  1   2 ; McGill Task Force on the Impact of COVID-19 on Cancer Control and Care
Affiliations

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

Talía Malagón et al. Int J Cancer. .

Abstract

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.

Keywords: COVID-19; cancer mortality; decision model; time to diagnosis; time to treatment.

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Conflict of interest statement

Talía Malagón, Jean H. E. Yong and Parker Tope have no conflicts of interest to disclose. Eduardo L. Franco reports grants to his institution from CIHR to assist the conduct of the study; he also reports the following disclosures about activities unrelated to the present paper: personal fees from Merck; a patent related to the discovery “DNA methylation markers for early detection of cervical cancer,” registered at the Office of Innovation and Partnerships, McGill University, Montreal, Quebec, Canada. Wilson H. Miller Jr. reports grants to his institution from Merck, CIHR, Cancer Research Society, Terry Fox Research Institute, Samuel Waxman Cancer Research Foundation and CCSRI; consulting fees from Merck, BMS, Roche, GSK, Novartis, Amgen, Mylan, EMD Serono; honoraria from McGill university, Jewish General Hospital, BMS, Merck, Roche, GSK, Novartis, Amgen, Mylan, EMD Serono; payments for participation on an advisory board from BMS, Merck, Roche, Novartis, Amgen, GSK; and payments to his institution for participation in a clinical trial within the past 2 years from BMS, Novartis, GSK, Roche, AstraZeneca, Methylgene, MedImmune, Bayer, Amgen, Merck, Incyte, Pfizer, Astellas, Genetech, Ocellaris Pharma, MIMIC, Exelixis, Roche, Alkermes.

Figures

FIGURE 1
FIGURE 1
Model conceptual diagram
FIGURE 2
FIGURE 2
Impact of the COVID‐19 pandemic on cancer treatments and hospitals in Canada. (A) Modeled percent change in cancer treatments for Canada as a whole. The percent change in surgeries is based on data on the volume of cancer surgeries in 2020 to 2021 relative to the same month in 2019, using data from the Canadian Institute of Health Information portal extracted on 28 May 2021. The percent change in radiotherapies is based on the yearly volume of radiotherapies in 2020 relative to 2019 reported by the Canadian Institute of Health Information, rescaled by month using the surgery data. Chemotherapies were assumed to follow the same changes as radiotherapies. (B) Number of people hospitalized for COVID‐19 in Canada from February 2020 to May 2021. Data compiled by Radio‐Canada extracted on 1 June 2021.
FIGURE 3
FIGURE 3
Predicted monthly (A) cancer incidence and (B) cancer deaths for all cancer sites combined, Canada. Lines are the median of 10 stochastic simulations for each scenario, and shaded areas represent the minimum‐maximum range. The pandemic scenario assumes that treatment capacity changes occur starting in June 2021, and that each 4‐week delay in cancer care increases the rate of cancer mortality by 6% (hazard ratio of 1.06)
FIGURE 4
FIGURE 4
Predicted yearly excess cancer deaths compared to those expected without the pandemic for all cancer sites combined, Canada. Results are the median and error bars are the minimum and maximum of 10 stochastic simulations for the base case scenario (recovery in June 2021), and scenarios with ±10% treatment capacity over prepandemic levels starting June 2021. Percentages indicate the yearly median relative increase in cancer deaths over expected
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Comment in

  • Global impact of COVID-19 pandemic on gastric cancer patients.
    Herrera-Kok JH, Parmar C, Bangash AH, Samadov E, Demirli Atici S, Cheruvu CV, Abouelazayem M, Yang W, Galanis M, Di Maggio F, Isik A, Bandopyadaya S, Viswanath YK. Herrera-Kok JH, et al. Eur J Surg Oncol. 2023 Apr;49(4):876-877. doi: 10.1016/j.ejso.2023.02.016. Epub 2023 Mar 2. Eur J Surg Oncol. 2023. PMID: 36898901 Free PMC article. No abstract available.

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