One in seven cancer patients around the world missed out on potentially life-saving operations during COVID-19 lockdowns, according to a study that used data from 65 countries, including India. The study, published in The Lancet Oncology journal on Wednesday, found that planned cancer surgery was affected by lockdowns regardless of the local COVID-19 rates at that time, with patients in lower income countries at highest risk of missing their surgery.
While lockdowns have been essential in protecting the general public from spreading infection, they have had collateral impact on care for other patients and health conditions, the researchers said. In one of the first studies that have measured these effects directly, researchers led by the University of Birmingham in the UK showed that lockdowns led to significant delays to cancer surgery and potentially more cancer deaths.
These could have been prevented if operations had gone ahead on time, they noted. The study analysed data from the 15 most common solid cancer types in 20,000 patients across 466 hospitals in 61 countries. It included data from 1,566 patients across 15 centres in India.
The researchers compared cancellations and delays before cancer surgery during lockdowns to those during times with light restrictions only. During full lockdowns, one in seven patients (15 per cent) did not receive their planned operation after a median of 5.3 months from diagnosis — all with a COVID-19 related reason for non-operation, they said.
However, during light restriction periods, the non-operation rate was very low (0.6 per cent). Patients awaiting surgery for more than six weeks during full lockdown were significantly less likely to have their planned cancer surgery.
Frail patients, those with advanced cancer, and those waiting surgery in lower-middle income countries were all less likely have the cancer operation they urgently needed. "Our research reveals the collateral impact of lockdowns on patients awaiting cancer surgery during the pandemic," said study co-lead author James Glasbey, from the University of Birmingham. "Whilst lockdowns are critical to saving lives and reducing the spread of the virus, ensuring capacity for safe elective cancer surgery should be part of every country's plan to ensure continued health across the whole population," Glasbey said.
In order to prevent further harm during future lockdowns, the researchers noted that the systems around elective surgery must be made more resilient. They also emphasised on protecting elective surgery beds and operating theatre space, and properly resourcing 'surge' capacity for periods of high demand on the hospital, whether that is COVID, the flu or other public health emergencies.
"The most vulnerable patients to lockdown effects were those in lower income countries, where capacity issues that were present before the pandemic were worsened during lockdown restrictions, said co-lead author Aneel Bhangu, from the University of Birmingham. "Patients in these environment were at highest risk of cancellation, despite being younger and having fewer co-morbidities," Bhangu said. While the researchers followed patients that underwent a delay for a short period of time, evidence from other research suggests that these patients may be at higher risk of recurrence, the researchers said.
To help mitigate this, surgeons and cancer doctors should consider closer follow-up for patients that were subject to delays before surgery, they said. Researchers analysed data from adult patients suffering from cancer types including colorectal, oesophageal, gastric, head and neck, thoracic, liver, pancreatic, prostate, bladder, renal, gynaecological, breast, soft-tissue sarcoma, bony sarcoma, and intracranial malignancies.
The team believes that this data can help inform governments when making decisions about whether to prolong or reduce restrictions. Country-level lockdowns have a direct impact on hospital procedures and planning, as health systems change to reflect stringent government policies restricting movement, the researchers said.
They found that full and moderate lockdowns independently increased the likelihood of non-operation after adjustment for local COVID-19 case notification rates.