A pair of studies today estimated the COVID-19 pandemic’s potential effects on cancer deaths, with one predicting rising US cancer deaths over the next decade owing to screening deficits, and the other suggesting that cancer surgery delays in Ontario could lead to poorer survival rates.
To accommodate surges of critically ill COVID-19 patients, many healthcare facilities around the world canceled or delayed appointments for other indications, including cancer. Before COVID-19 vaccines were available, patients with nonemergent conditions also were advised to stay home rather than risk infection in crowded hospitals or clinics.
The unintended consequences of these public health measures are still being measured.
Median 18% drop in colorectal cancer screening
In the first study, published in Cancer, a team led by Northwestern University researchers conducted a national quality-improvement (QI) study on the return to cancer screening among 748 accredited US cancer programs from April through June 2021. They used prepandemic and pandemic monthly screening test volumes (MTVs) to identified screening gaps.
Most facilities reported gaps in monthly screenings for colorectal cancer (104 of 129 [80.6%]), cervical cancer (20/29 [69.0%]), breast cancer (241/436 [55.3%]), and lung cancer (98/220 [44.6%]).
The median relative changes in MTVs were -17.7% for colorectal cancer, -6.8% for cervical cancer, -1.6% for breast cancer, and 1.2% for lung cancer. No geographic differences were seen.
These findings prompted participating cancer programs to start 814 QI projects to break down barriers to cancer screening, including screening resources. While the effects of these projects on screening rates through 2021 are still being evaluated, the estimated numbers of potential MTVs, should all facilities reach their target goals, could be 57,141 for breast cancer, 6,079 for colorectal cancer, 4,280 for cervical cancer, and 1,744 for lung cancer.
“Cancer screening is still in need of urgent attention, and the screening resources made available online may help facilities to close critical gaps and address screenings missed in 2020,” the researchers wrote.
In a press release from Wiley, publisher of the journal, corresponding author Heidi Nelson, MD, of the American College of Surgeons, said that the team hopes that the QI programs will prevent many cancer deaths.
“From the perspective of what this means about our programs, we now know that we can turn to our accredited programs in times of crisis to help address large-scale cancer problems,” she said. “Knowing how enthusiastic these accredited programs are for working collaboratively on national level problems, we expect to release one or two quality improvement projects each year going forward.”
10-year survival could fall up to 0.9%
To assess the effect of COVID-19–related cancer surgery delays on survival, University of Toronto researchers built a microsimulation model using real-world population data on cancer care in Ontario from 2019 and 2020.
The study, published in the Canadian Medical Association Journal (CMAJ), estimated cancer surgery wait times over the first 6 months of the pandemic by simulating a slowdown in operating room capacity (60% operating room resources in month 1, 70% in month 2, and 85% in months 3 to 6), compared with simulated prepandemic conditions with 100% resources.
The model population consisted of 22,799 patients awaiting cancer surgery before the pandemic and 20,177 new referrals. Average wait time to surgery before the pandemic was 25 days, compared with 32 days after. As a result, 0.01 to 0.07 life-years were lost per patient across cancer types, translating to 843 life-years lost among cancer patients.
The largest percentages of life-years lost were among patients with nonprostate genitourinary (0.07 life-years lost), gastrointestinal (0.05), and head and neck cancers (0.05), all of which carry a high risk of death. Ten-year survival fell by 0.3% to 0.9% across all studied cancer types in the pandemic model compared with the prepandemic era, with the greatest change in patients with hepatobiliary cancers (26.0% before vs 25.1% after).
In a scenario of a 60% reduction in surgical resources for cancer patients in the first 6 months of the pandemic, incremental increases in wait time of 10 to 21 days over prepandemic wait times translated to 0.1 to 0.11 life-years lost per patient and reductions in 10-year survival of 0.3 to 1.6 percentage points across cancer types. The changes indicate the loss of 1,539 life-years.
In a different scenario in which surgical resources were reduced to 60% for the first 2 months of the pandemic and raised to 75% for the next 4 months, wait times were shorter than under the first scenario (incremental increase, 8 to 19 days), leading to the loss of fewer (1,306) life-years.
The study authors called for future studies to characterize the additional impact of pandemic-related diagnostic delays and changes in cancer stage on cancer survival.
“Pandemic-related slowdowns of cancer surgeries were projected to result in decreased long-term survival for many patients with cancer,” they wrote. “Measures to preserve surgical resources and health care capacity for affected patients are critical to mitigate unintended consequences.”
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
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