{"id":26204,"date":"2020-07-21T08:12:04","date_gmt":"2020-07-21T08:12:04","guid":{"rendered":"https:\/\/scienceblog.cancerresearchuk.org\/?p=17772"},"modified":"2024-11-03T15:16:22","modified_gmt":"2024-11-03T15:16:22","slug":"why-its-difficult-to-estimate-the-number-of-extra-cancer-deaths-caused-by-service-disruption-during-covid-19","status":"publish","type":"post","link":"https:\/\/ogkologos.com\/en\/why-its-difficult-to-estimate-the-number-of-extra-cancer-deaths-caused-by-service-disruption-during-covid-19\/","title":{"rendered":"Why it\u2019s difficult to estimate the number of extra cancer deaths caused by service disruption during COVID-19"},"content":{"rendered":"
<\/div>\n

If you have questions about cancer, you can talk to our nurses Monday to Friday, 9-5pm, on freephone 0808 800 4040.<\/em><\/p>\n

Every week, a new figure comes out.<\/p>\n

And despite the fact that they\u2019re all trying to estimate the same thing \u2013 the number of extra cancer deaths that could be caused by service disruption during the pandemic \u2013 there\u2019s a big range. Anything from 3,300<\/a> to 60,000<\/a> so far.<\/p>\n

That\u2019s because estimating the impact of COVID-19 on cancer outcomes is not an easy thing to do. In fact, it\u2019s almost impossible.<\/p>\n

As the stats saying goes \u201call models are wrong, but some are useful\u201d. And while there\u2019s been a lot of variation in estimates so far, each serves to highlight the negative impact for people with cancer and just how important it is to get cancer services back up and running.<\/p>\n

Because while COVID-19 has placed unimaginable stress on health services, it\u2019s vital to provide safe services for patients so that the pandemic doesn\u2019t also cause an increase in deaths from other conditions like cancer.<\/p>\n

Changes across the board<\/h2>\n

\u201cWe know there is going to be an impact on cancer survival from COVID-19, and it can only be a negative impact,\u201d says Jon Shelton, Cancer Research UK\u2019s senior intelligence manager.<\/p>\n

\u201cScreening effectively stopped during the pandemic, the number of people being referred for diagnostic tests dropped massively and a lot of tests and treatments for cancer were postponed.\u201d<\/p>\n

Shelton says the impact of COVID-19 has been felt across the board, with certain diagnostic procedures \u2013 like endoscopies \u2013 being stopped because they were considered too risky<\/a> for both patients and healthcare staff.<\/p>\n

Cancer treatment has been affected too, with surgery disrupted the most \u2013 falling by up to 40% of what would have been expected. Some complex surgeries were cancelled because there weren\u2019t enough ITU beds for patients after operations.<\/p>\n

Last month, we estimated that over 2 million people<\/a> in the UK were waiting for cancer screening, tests or treatment. Another estimate, but one that has fewer assumptions.<\/p>\n

Because while all the figures so far point towards a negative impact on cancer survival in the UK, the size of the impact is difficult to predict.<\/p>\n

\u201cThere\u2019s still so much uncertainty across the pathway \u2013 from screening and diagnosis to treatment, monitoring and care,\u201d says Shelton. With that level of disruption, it\u2019s difficult to know how all the changes will add up.<\/p>\n

To get around this challenge, some estimates have focused on a single aspect of cancer care, like surgery, with one study<\/a> estimating that there would be around 10,600 excess deaths from delaying surgery for 6 months.<\/p>\n

\u201cWe know that complex surgery has been affected, but right now we don\u2019t have the evidence to suggest how this will affect outcomes, especially with other treatment options being used\u201d says Shelton. \u201cFor some slow growing tumours, there may not be much difference in outcomes, but for other cancer sites, outcomes could vary much more.\u201d<\/p>\n

The study didn\u2019t account for the fact that some people who would usually have surgery have had radiotherapy instead, to reduce the size of the tumour until it\u2019s safe to operate.<\/p>\n

Shelton says that the impact of these changes for some patients may be more to do with side effects or quality of life, rather than survival. Something that a single figure of excess deaths will never be able to encapsulate.<\/p>\n

Missing pieces<\/h2>\n

Studies that take a broader view may also run into problems, because there\u2019s a lot of important information that we just don\u2019t have.<\/p>\n

Take cancer diagnosis. We know that in some places urgent cancer referrals plummeted to around 25% of usual numbers at the peak of the pandemic, as fewer people were going to their GP with symptoms and some were reluctant to go to secondary care for further tests due to the risks of COVID-19.<\/p>\n

While the figures are worrying, this doesn\u2019t necessarily mean that the number of people diagnosed has fallen by the same amount, because most people who are urgently referred do not have cancer.<\/p>\n

\u201cIt may be that the proportion of people urgently referred during COVID-19 who go on to be diagnosed with cancer is higher than usual,\u201d says Shelton. \u201cWe won\u2019t know the scale until we have those figures, but we do know that many patients\u2019 diagnosis has been delayed and we need to address this urgently \u2013 a delay to diagnosis could lead to the tumour growing and even spreading, which is harder to treat.\u201d<\/p>\n

But even with all this information, the size of the negative impact is still difficult to predict.<\/p>\n

\u201cWith cancer, we don\u2019t usually wait to diagnose or treat someone \u2013 if we know someone has cancer we want them to receive the best treatment without delay, so we don\u2019t have the evidence for what will happen if we do wait.\u201d<\/p>\n

Shelton says the size of the impact will also vary from cancer to cancer. \u201cSome tumours grow quite slowly, and therefore a delay may not impact survival very much at all,\u201d says Shelton. \u201cWhereas for other more aggressive tumours, it could lead to the disease spreading and a much larger impact on survival.\u201d<\/p>\n

While it\u2019s possible to make assumptions to fill in some of these gaps, the sheer number of unknowns mean slight changes in each can have a big effect on the final estimate.<\/p>\n

It\u2019s still unfolding<\/h2>\n

Finally, with the pandemic still unfolding, the true impact of COVID-19 on cancer deaths will also depend on what happens next.<\/p>\n

\u201cWe\u2019re seeing movement in the right direction with the health service \u2013 screening programmes are restarting and urgent cancer referrals are going up. But it will really depend on how quickly we can get services back to, and preferably better than, pre-COVID levels.\u201d<\/p>\n

Shelton believes it\u2019s vital to collect as much as evidence as possible during the pandemic, to allow researchers to really understand what changes were made and the effect they had. Not only to make sure we\u2019re prepared for potential future waves, but so we can improve cancer services in the future.<\/p>\n

And while it\u2019s likely we\u2019ll not know the full impact of COVID-19 on cancer survival for many years, Shelton believes the estimates can form an important part of the discussion.<\/p>\n

\u201cAccurately estimating excess deaths is virtually impossible right now, but they show what could happen if certain scenarios play out. These estimates all strongly emphasise the importance of getting cancer services back on track as soon and as safely as possible, to minimise any further negative impact for people with cancer.\u201d<\/p>\n

We\u2019re keen to capture the full impact on people affected by cancer. We\u2019ve run a survey to understand more about the experiences of people across the country and how COVID-19 is affecting them.<\/p>\n

Katie <\/em><\/p>\n

If you have questions about cancer, you can talk to our nurses Monday to Friday, 9-5pm, on freephone 0808 800 4040.<\/em><\/p>\n

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Read more:<\/strong><\/p>\n<\/div>\n

More on this topic<\/h3>\n<\/p>\n

Source<\/a><\/p>","protected":false},"excerpt":{"rendered":"

If you have questions about cancer, you can talk to our nurses Monday to Friday, 9-5pm, on freephone 0808 800 4040. Every week, a new figure comes out. And despite the fact that they\u2019re all trying to estimate the same thing \u2013 the number of extra cancer deaths that could be caused by service disruption […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"footnotes":""},"categories":[5137],"tags":[],"class_list":["post-26204","post","type-post","status-publish","format-standard","hentry","category-world-news"],"_links":{"self":[{"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/posts\/26204","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/comments?post=26204"}],"version-history":[{"count":1,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/posts\/26204\/revisions"}],"predecessor-version":[{"id":44219,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/posts\/26204\/revisions\/44219"}],"wp:attachment":[{"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/media?parent=26204"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/categories?post=26204"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/tags?post=26204"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}