☆ 4.2 Article

An inverse stage-shift model to estimate the excess mortality and health economic impact of delayed access to cancer services due to the COVID-19 pandemic

ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY (2021)

Journal

ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY

Volume 17, Issue 4, Pages 359-367

Publisher

WILEY

DOI: 10.1111/ajco.13505

Keywords

COVID-19; diagnostic delays; economic outcomes; health outcomes; modeling; oncology; stage shift; time to treatment initiation; treatment delays

Funding

Melanoma Research Victoria
Victorian Government through the Victorian Cancer Agency Translational Research Program

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Abstract

The study shows that the COVID-19 pandemic has delayed cancer diagnosis and treatment, impacting survival outcomes and healthcare costs. Based on Australian data, even a conservative once-off 3-month delay is predicted to result in 88 excess deaths and $12 million excess healthcare costs.

Aim Decreased cancer incidence and reported changes to clinical management indicate that the COVID-19 pandemic has delayed cancer diagnosis and treatment. This study aimed to develop and apply a flexible model to estimate the impact of delayed diagnosis and treatment on survival outcomes and healthcare costs based on a shift in the disease stage at treatment initiation. Methods A model was developed and made publicly available to estimate population-level health economic outcomes by extrapolating and weighing stage-specific outcomes by the distribution of stages at treatment initiation. It was applied to estimate the impact of 3- and 6-month delays based on Australian data for stage I breast cancer, colorectal cancer, and lung cancer patients, and for T1 melanoma. Two approaches were explored to estimate stage shifts following a delay: (a) based on the relation between time to treatment initiation and overall survival (breast, colorectal, and lung cancer), and (b) based on the tumor growth rate (melanoma). Results Using a conservative once-off 3-month delay and considering only shifts from stage I/T1 to stage II/T2, 88 excess deaths and $12 million excess healthcare costs were predicted in Australia over 5 years for all patients diagnosed in 2020. For a 6-month delay, excess mortality and healthcare costs were 349 deaths and $46 million over 5 years. Conclusions The health and economic impacts of delays in treatment initiation cause an imminent policy concern. More accurate individual patient data on shifts in stage of disease during and after the COVID-19 pandemic are critical for further analyses.

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Survival outcomes following treatment delays among patients with early-stage female cancers: a nationwide study

Yu Min, Zheran Liu, Rendong Huang, Ruidan Li, Jing Jin, Zhigong Wei, Ling He, Yiyan Pei, Ning Li, Yongllin Su, Xiaolin Hu, Xingchen Peng

Summary: The COVID-19 pandemic has had a significant impact on the timely receipt of healthcare for cancer patients, particularly female patients. Treatment delays can lead to increased depression and anxiety in female patients, emphasizing the need to investigate the impact of these delays on the survival outcomes of early-stage female cancer patients.

JOURNAL OF TRANSLATIONAL MEDICINE (2022)