Delayed care for patients with newly diagnosed cancer due to COVID-19 and estimated impact on cancer mortality in France

Abstract

Background: The impact of the first coronavirus disease 2019 (COVID-19) wave on cancer patient management was measured within the nationwide network of the Unicancer comprehensive cancer centers in France.

Patients and methods: The number of patients diagnosed and treated within 17 of the 18 Unicancer centers was collected in 2020 and compared with that during the same periods between 2016 and 2019. Unicancer centers treat close to 20% of cancer patients in France yearly. The reduction in the number of patients attending the Unicancer centers was analyzed per regions and cancer types. The impact of delayed care on cancer-related deaths was calculated based on different hypotheses.

Results: A 6.8% decrease in patients managed within Unicancer in the first 7 months of 2020 versus 2019 was observed. This reduction reached 21% during April and May, and was not compensated in June and July, nor later until November 2020. This reduction was observed only for newly diagnosed patients, while the clinical activity for previously diagnosed patients increased by 4% similar to previous years. The reduction was more pronounced in women, in breast and prostate cancers, and for patients without metastasis. Using an estimated hazard ratio of 1.06 per month of delay in diagnosis and treatment of new patients, we calculated that the delays observed in the 5-month period from March to July 2020 may result in an excess mortality due to cancer of 1000-6000 patients in coming years.

Conclusions: In this study, the delays in cancer patient management were observed only for newly diagnosed patients, more frequently in women, for breast cancer, prostate cancer, and nonmetastatic cancers. These delays may result is an excess risk of cancer-related deaths in the coming years.

Keywords: COVID-19; cancer; delay; diagnosis; treatment.

Figure 1

Number of newly diagnosed patients per month from 2016 to 2020.

Figure 2

Relative number of newly diagnosed patients in 2020 versus 2019 in men and women. (A) Relative proportion of cases per month in men and women: total numbers (blue and orange curves for men and women, respectively) and with metastases (gray and yellow curves for men and women, respectively). The P values correspond to the comparison of the total new cases in men and women per month in 2019 versus 2020. Significant differences were observed from March to July for the total population. The same trend is observed for metastatic patients at diagnosis, but no significant difference was observed. (B) Relative number of newly diagnosed male patients. Relative numbers for each month in 2017 versus 2016 (blue), 2018 versus 2017 (orange), 2019 versus 2018 (gray), and 2020 versus 2019 (yellow). (C) Relative number of newly diagnosed female patients. Relative numbers for each month in 2017 versus 2016 (blue), 2018 versus 2017 (orange), 2019 versus 2018 (gray), and 2020 versus 2019 (yellow).

Figure 3

Relative and absolute numbers of newly diagnosed cancers in 2020 versus 2019. (A) Relative number of newly diagnosed patients with cancers of different organs and sites: x-axis: months of 2020; y-axis: relative proportion of newly diagnosed patients per month in 2020 versus 2019. Highlighted in blue: lockdown 1 period. Highlighted in yellow: higher number of newly diagnosed in patients in 2020 versus 2019. (B) Absolute number of newly diagnosed patients with cancers of different organs and sites: x-axis: months of 2020; y-axis: total number of newly diagnosed patients per month in 2020 versus 2019, for the different cancer types. Orange curve represents the total. Green curve represents breast cancers. (C) Relative number of newly diagnosed cancers in 2020 versus 2019: genitourinary and gynecological cancers. x-axis: months of 2020; y-axis: relative proportion of newly diagnosed patients per month in 2020 versus 2019. Highlighted in blue: lockdown 1 period. Highlighted in yellow: higher number of newly diagnosed patients in 2020 versus 2019. (D) Relative number of newly diagnosed cancers in 2020 versus 2019: gastrointestinal and skin cancers. x-axis: months of 2020, y-axis: relative proportion of newly diagnosed patients per month in 2020 versus 2019. Highlighted in blue: lockdown 1 period. Highlighted in yellow: higher number of new diagnosed in patients in 2020 versus 2019. GI, gastrointestinal; GU, genitourinary; Gyn, gynecological; H&N, head and neck; Hematol, hematological.

Figure 3

Relative and absolute numbers of newly diagnosed cancers in 2020 versus 2019. (A) Relative number of newly diagnosed patients with cancers of different organs and sites: x-axis: months of 2020; y-axis: relative proportion of newly diagnosed patients per month in 2020 versus 2019. Highlighted in blue: lockdown 1 period. Highlighted in yellow: higher number of newly diagnosed in patients in 2020 versus 2019. (B) Absolute number of newly diagnosed patients with cancers of different organs and sites: x-axis: months of 2020; y-axis: total number of newly diagnosed patients per month in 2020 versus 2019, for the different cancer types. Orange curve represents the total. Green curve represents breast cancers. (C) Relative number of newly diagnosed cancers in 2020 versus 2019: genitourinary and gynecological cancers. x-axis: months of 2020; y-axis: relative proportion of newly diagnosed patients per month in 2020 versus 2019. Highlighted in blue: lockdown 1 period. Highlighted in yellow: higher number of newly diagnosed patients in 2020 versus 2019. (D) Relative number of newly diagnosed cancers in 2020 versus 2019: gastrointestinal and skin cancers. x-axis: months of 2020, y-axis: relative proportion of newly diagnosed patients per month in 2020 versus 2019. Highlighted in blue: lockdown 1 period. Highlighted in yellow: higher number of new diagnosed in patients in 2020 versus 2019. GI, gastrointestinal; GU, genitourinary; Gyn, gynecological; H&N, head and neck; Hematol, hematological.