The Impact of the COVID-19 Pandemic on Incidence and Short-Term Survival for Common Solid Tumours in the United Kingdom: A Cohort Analysis

Abstract

Purpose

The COVID-19 pandemic profoundly affected healthcare systems and patients. There is a need to comprehend the collateral effects of the pandemic on non-communicable diseases. We examined the impact of the pandemic on short-term survival for common solid tumours, including breast, colorectal, head and neck, liver, lung, oesophageal, pancreatic, prostate, and stomach cancer in the UK.

Methods

This was a population-based cohort study of electronic health records from the UK primary care Clinical Practice Research Datalink GOLD database. In sum, 12,259,744 eligible patients aged ≥18 years with ≥1 year’s history identified from January 2000 to December 2022 were included. We estimated age-standardised incidence and short-term (one- and two-year) survival for several common cancers from 2000 to 2019 (in five-year strata) and compared these to 2020–2022 using the Kaplan–Meier method.

Results

Incidence decreased for most cancers in 2020 and recovered to different extents in 2021–2022. Short-term survival improved for most cancers between 2000 and 2019, but then declined, albeit minimally, for those diagnosed in 2020–2022. This was most pronounced for colorectal cancer, with one-year survival falling from 78.8% (95% CI 78%–79.6%) in 2015–2019 to 77% (95% CI 75.6–78.3%) for those diagnosed in 2020–2022.

Conclusion

Short-term survival for many cancers was impacted, albeit minimally, by the pandemic in the UK, with reductions in survivorship from colorectal cancer equivalent to returning to the mortality seen in the first decade of the 2000s. While data on longer-term survival are needed to fully comprehend the impact of COVID-19 on cancer care, our findings illustrate the need for an urgent and substantial commitment from the UK National Health Service to address the existing backlog in cancer screening and diagnostic procedures to improve cancer care and mortality.

Keywords:

• cancer
• COVID-19
• colorectal cancer
• incidence
• pandemic
• survival

Acknowledgments

This study was funded by the European Health Data & Evidence Network (EHDEN) and the Optimal treatment for Patients with Solid Tumours in Europe through Artificial Intelligence (OPTIMA) initiative, which has received funding from the Innovative Medicines Initiative 2 (IMI2) Joint Undertaking under grant agreements 806968 and 101034347, respectively. IMI2 receives support from the European Union’s Horizon 2020 research and innovation programme and the European Federation of Pharmaceutical Industries and Associations (EFPIA). IMI supports collaborative research projects and builds networks of industrial and academic experts in order to boost pharmaceutical innovation in Europe. The views communicated within are those of OPTIMA and EHDEN. Neither the IMI nor the European Union, EFPIA, or any associated partners are responsible for any use that may be made of the information contained herein. AWR would like to thank Professor Ismail Gögenur and Dr Mikail Gögenur for discussions regarding development of the colorectal cancer phenotyping used in this study. The study funders had no role in the conceptualisation, design, data collection, analysis, decision to publish, or preparation of the manuscript. This paper is also available on medRxiv as a preprint, which can be found here: https://doi.org/10.1101/2023.09.14.23295563

Disclosure

NB reports personal fees from Sleep Universal, Roche and Theramex, outside the submitted work. DPA receives funding from the UK National Institute for Health and Care Research (NIHR) in the form of a senior research fellowship. DPA’s group received partial support from the Oxford NIHR Biomedical Research Centre. DPA’s department has received grant/s from Amgen, Chiesi-Taylor, Lilly, Janssen, Novartis, and UCB Biopharma. His research group has received consultancy fees from AstraZeneca and UCB Biopharma. Amgen, Astellas, Janssen, Synapse Management Partners, and UCB Biopharma have funded or supported training programmes organised by DPA’s department. ÀRS reports honoraria for presentations, lectures, speakers, support for attending meetings and travel from Janssen, Astellas, and Bayer and support for attending meetings and travel from Ipsen outside the submitted work. FX-A-J is funded by Fundación Cientifica AECC (LABAE18025AVIL) and Plan Estatal de I+D+I of the Instituto de Salud Carlos III (FIS PI15/02047 and FIS PI18/0844). DN reports grants from OPTIMA and EHDEN. All other authors declare no conflicts of interest in this work.