Intended for healthcare professionals


Covid-19: Cancer mortality could rise at least 20% because of pandemic, study finds

BMJ 2020; 369 doi: (Published 29 April 2020) Cite this as: BMJ 2020;369:m1735

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  1. Jacqui Wise
  1. London

A new analysis estimates that at least 6270 additional deaths could occur in England over the next 12 months in patients with new cancer diagnoses—a 20% increase—as a result of the covid-19 pandemic.1

This number could rise to an estimated 17 915 additional deaths if all people who currently have cancer are considered, said the research from University College London and Data-Can, a health data research hub for cancer diagnosis and treatment.

Some of the excess deaths will be among people with cancer who contract covid-19, while others will occur because diagnosis was late or treatment such as chemotherapy was delayed, the researchers concluded.

The study came as the NHS warned people with cancer symptoms not to hesitate to get checked, after a poll found that nearly half of the public had concerns about seeking help during the coronavirus pandemic.

The analysis, which uses data from the health records of 3.8 million patients in England, is published as a pre-print and so has not yet been fully peer reviewed. It estimates that, before the pandemic, about 31 354 patients with newly diagnosed cancer will die within a year in England.

The researchers analysed real time weekly hospital data from eight hospitals in the UK and found a 76% decrease in urgent referrals from GPs of people with suspected cancers and a 60% reduction in chemotherapy appointments from pre-covid-19 levels. They said that these large declines might be due to workforce capacity or resources being redirected to care for patients with covid-19 and the desire of clinicians and patients to minimise the risks of infection.

Unintended consequences

Alvina Lai, lead author, from the UCL Institute of Health Informatics, said, “Our findings demonstrate the serious potential for unintended consequences of the response to the covid-19 pandemic, which may negatively impact on patients with cancer and other underlying health conditions. It is vital that these patients are recognised as being vulnerable and that their care is managed appropriately.”

The analysis also modelled publicly available data from the United States and showed that an additional 33 890 deaths could occur in US patients with newly diagnosed cancer over the next year.

Funding for the study was provided from Health Data Research UK and the National Institute of Health Research University College London Hospitals Biomedical Research Centre.

The study authors said that patients with cancer and multimorbidity were a group particularly at risk during the current covid-19 pandemic. Publish weekly national data on mortality and cancer services activity is vital, they urged, to help understand which disease combinations pose the greatest risk to life and to inform how health services should be prioritised.

Harry Hemingway, director of UCL Institute of Health Informatics and senior author, said, “The overall impact of the covid-19 emergency on deaths in cancer patients could be substantial. There are many factors operating here including rapid changes to diagnosis and treatment protocols, social distancing measures, changes in people’s behaviour in seeking medical attention, and the economic impact of covid-19, as well as deaths due to covid-19 infection.”

Peter Johnson, NHS national clinical director for cancer, urged people to continue to seek help if they experienced signs of cancer. He said, “We know that finding cancer early gives us the best chance to cure it, and ignoring potential problems can have serious consequences now or in the future.” He added that GPs could provide online consultations and that 19 areas of the country now had virus protected cancer hubs.