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@article{Sud:2020:10.1016/S1470-2045(20)30392-2,
author = {Sud, A and Torr, B and Jones, M and Broggio, J and Scott, S and Loveday, C and Garrett, A and Gronthoud, F and Nicol, D and Jhanji, S and Boyce, S and Williams, M and Riboli, E and Muller, D and Kipps, E and Larkin, J and Navani, N and Swanton, C and Lyratzopoulos, G and McFerran, E and Lawler, M and Houlston, R and Turnbull, C},
doi = {10.1016/S1470-2045(20)30392-2},
journal = {The Lancet Oncology},
pages = {1035--1044},
title = {Effect of delays in the UK two-week wait cancer referral pathway during the COVID-19 pandemic on cancer survival: a modelling study},
url = {http://dx.doi.org/10.1016/S1470-2045(20)30392-2},
volume = {21},
year = {2020}
}

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TY  - JOUR
AB  - Background: During the COVID-19 lockdown, referrals via the 2 Week Wait (2WW) urgent pathway for suspected cancer in England are reported to have dropped by up to 84%. We aimed to examine the impact on cancer survival of different scenarios of lockdown accumulated-backlog. We also aimed to examine by tumour-referral-group and age, survival benefit per referred patient considering survival decrement from delayed referral versus risk of death from nosocomial SARS-CoV-2 infection.Methods: To construct the underlying models, we used age- and stage-stratified 10 year cancer survival estimates for England 2007-2017 for 20 common tumour-types. We applied per-day hazard ratios for cancer progression generated from observational studies of delay to-treatment. We quantified the annual numbers of cancers diagnosed via the 2WW-pathway using the 2WW age- and stage-specific breakdowns. From these, for per-patient delays of 1- 6 months, we estimated aggregate number of lives lost and life-years lost in England. Using referral-to-diagnosis conversion rates and COVID-19 case fatality rates, we also estimated the survival increment per patient referred. Findings: Per month across England in 2013-2016, on average 6,281 patients with Stage 1- 3 cancer were diagnosed via the 2WW pathway of whom 1,691 would be predicted to die within 10 years from their disease. We estimated 2WW-pathway presentational-delay from three months of lockdown will result in total in 181/361/542 attributable additional deaths (if % reduction in referrals was 25/50/75% respectively). Limited diagnostic capacity to address the backlog may result in additional delays: 401/811/1,231 attributable additional deaths are estimated if additional diagnostic capacity is delayed until months 3-8 post-lockdown. 2-month delay in 2WW investigatory referral results in average loss of life-years per-referred-patient of between 0 and 0.7, depending on age and tumour-type. Interpretation: Prompt provision of additional capacity f
AU  - Sud,A
AU  - Torr,B
AU  - Jones,M
AU  - Broggio,J
AU  - Scott,S
AU  - Loveday,C
AU  - Garrett,A
AU  - Gronthoud,F
AU  - Nicol,D
AU  - Jhanji,S
AU  - Boyce,S
AU  - Williams,M
AU  - Riboli,E
AU  - Muller,D
AU  - Kipps,E
AU  - Larkin,J
AU  - Navani,N
AU  - Swanton,C
AU  - Lyratzopoulos,G
AU  - McFerran,E
AU  - Lawler,M
AU  - Houlston,R
AU  - Turnbull,C
DO  - 10.1016/S1470-2045(20)30392-2
EP  - 1044
PY  - 2020///
SN  - 1213-9432
SP  - 1035
TI  - Effect of delays in the UK two-week wait cancer referral pathway during the COVID-19 pandemic on cancer survival: a modelling study
T2  - The Lancet Oncology
UR  - http://dx.doi.org/10.1016/S1470-2045(20)30392-2
UR  - https://www.sciencedirect.com/science/article/pii/S1470204520303922?via%3Dihub
UR  - http://hdl.handle.net/10044/1/80272
VL  - 21
ER  -

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