Impact of COVID-19 on healthcare organization and cancer outcomes
Ce dossier présente un ensemble d'articles concernant la prise en charge des cancers durant la crise sanitaire liée au COVID-19
Background : Changes in the management of cancer patients and delays in treatment delivery during the COVID-19 pandemic may impact use of hospital resources and cancer mortality.
Patients and methods : Patient flows, patient pathways and use of hospital resources during the pandemic were simulated using a discrete event simulation model and patient-level data from a large French comprehensive cancer center's discharge database, considering two scenarios of delays: massive return of patients from November 2020 (Early-Return) or March 2021 (Late-Return). Expected additional cancer deaths at 5 years and mortality rate were estimated using individual hazard ratios based on literature.
Results : The number of patients requiring hospital care during the simulation period was 13,000. In both scenarios, 6 to 8% of patients were estimated to present a delay of >2 months. The overall additional cancer deaths at 5 years were estimated at 88 in Early-Return and 145 in Late-Return scenario, with increased additional deaths estimated for sarcomas, gynecological, liver, head and neck, breast cancer and acute leukemia. This represents a relative additional cancer mortality rate at 5 years of 4.4 and 6.8% for patients expected in year 2020, 0.5 and 1.3% in 2021, and 0.5 and 0.5% in 2022 for each scenario, respectively.
Conclusions : Pandemic-related diagnostic and treatment delays in cancer patients are expected to impact patient survival. In the perspective of recurrent pandemics or alternative events requiring an intensive use of limited hospital resources, patients should be informed not to postpone care, and medical resources for cancer patients should be sanctuarized.
European Journal of Cancer , résumé, 2020