Background and Purpose: Most cancer deaths in the world are due to lung cancer and diagnosis and treatment delays sharply reduce survival in lung cancer patients. This study examined the impact of delays during the early months of the pandemic on the survival of newly identified lung cancer patients in Canada in 2020. Method: This was a secondary data analysis from published literature and openly available data sources. Cancer Statistics from existing literature were used as a proxy for the month-wise distribution of lung cancer cases in Canada. The incidence of lung cancer, using population statistics from Statistics Canada and incidence rates from the Canadian Cancer Statistics in 2020, was estimated. The population-based Excel model employed compounded cuts on the incidence to arrive at the outcomes. Plotdigitzer.com tool was used to digitize the survival versus time curves for each stage from secondary sources. Stage-wise incidences for each sex were calculated for each age group for each month of 2020. Using delay impact on each stage the final results were calculated. Results: A total of 5004 life years would have been lost due to 448 deaths in the long term (40 months) attributed to the delays caused during March, April, May and June in Canada. The estimated incidence for all stages of lung cancer for these months was 9801 although the observed incidence was expected to be 6571 due to reduced screenings. Hence, it was within the missing 3231 cases that delays would occur. Over the short term (10 months) there are expected to be 151 early deaths and 273 deaths in the intermediate-term (20 months). Conclusions: This study using a mathematical model showed that in 2020, the COVID epidemic resulted in higher mortality and fewer lung cancer diagnoses in Canada. As a result of the delays in assessment, screening, and treatment that accompanied the pandemic lockdowns, there has been a rise in total life years lost due to lung cancer, demonstrating the pandemic’s huge impact on lung cancer patients.
References
[1]
Stewart, B.W. and Wild, C.P. (2014) International Agency for Research on Cancer. World Cancer Report, IARC.
https://publications.iarc.fr/Non-Series-Publications/World-Cancer-Reports/World-Cancer-Report-2014
[2]
Canadian Cancer Society (2020) Canadian Cancer Statistics: A 2020 Special Report on Lung Cancer.
https://cdn.cancer.ca/-/media/files/cancer-information/resources/publications/2020-canadian-cancer-statistics-special-report/2020-canadian-cancer-statistics-special-report-en.pdf
[3]
Lewis, D.R., Check, D.P., Caporaso, N.E., et al. (2014) US Lung Cancer Trends by Histologic Type. Cancer, 120, 2883-2892.
https://pubmed.ncbi.nlm.nih.gov/25113306
[4]
Collaborative Staging Schema v02.05. American College of Surgeons. 1996-2021.
https://www.facs.org/quality-programs/cancer/ajcc/cs-schema
[5]
Bozcuk, H. and Martin, C. (2001) Does Treatment Delay Affect Survival in Non-Small Cell Lung Cancer? A Retrospective Analysis from a Single UK Centre. Lung Cancer, 34, 243-252. https://pubmed.ncbi.nlm.nih.gov/11679183
[6]
Myrdal, G., Lambe, M., Hillerdal, G., et al. (2004) Effect of Delays on Prognosis in Patients with Non-Small Cell Lung Cancer. Thorax, 59, 45-49.
https://pubmed.ncbi.nlm.nih.gov/14694247
[7]
Solis, M.A., Falco, J., Garcia, A.R., et al. (2016) Influence of Diagnosis and Treatment Delays on Survival of Lung Cancer. American Journal of Respiratory and Critical Care Medicine, 193, A4273.
https://www.atsjournals.org/doi/abs/10.1164/ajrccm-conference.2016.193.1_MeetingAbstracts.A4273
[8]
Johnson, B.A., Waddimba, A.C., Ogola, G.O., et al. (2021) A Systematic Review and Meta-Analysis of Surgery Delays and survival in Breast, Lung and Colon Cancers: Implication for Surgical Triage during the COVID-19 Pandemic. The American Journal of Surgery, 222, 311-318. https://pubmed.ncbi.nlm.nih.gov/33317814
[9]
Ricciardiello, L., Ferrari, C., Cameletti, M., et al. (2021) Impact of SARS-CoV-2 Pandemic on Colorectal Cancer Screening Delay: Effect on Stage Shift and Increased Mortality. Clinical Gastroenterology and Hepatology, 19, 1410-1417.e9.
https://pubmed.ncbi.nlm.nih.gov/32898707
[10]
Narcity. Covid-19 Social and Economic Impact-Timeline. Narcity.com.
https://www.narcity.com/media-library/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNjAxMDIzNC9vcmlnaW4ucG5nIiwiZXhwaXJlc19hdCI6MTY1NzgwOTM2Nn0.GheVsZWOJoFvq077rhiVv-aoq47oE28_w_9hhlo00rE/image.png?width=980
[11]
Johnston, M.P. (2017) Secondary Data Analysis: A Method of Which the Time Has Come. Qualitative and Quantitative Methods in Libraries, 3, 619-626.
http://www.qqml-journal.net/index.php/qqml/article/view/169
[12]
USCS (2020) United States Cancer Statistics. Month of Diagnosis.
https://wwwcdcgov/cancer/uscs/public-use/dictionary/month-of-diagnosishtm
[13]
Feeny, D., Kaplan, M.S., Huguet, N., et al. (2010) Comparing Population Health in the United States and Canada. Population Health Metrics, 8, 8-18.
https://doi.org/10.1186/1478-7954-8-8
[14]
Alanen, V. and Koivunen, J.P. (2019) Association of Diagnostic Delays to Survival in Lung Cancer: Single Center Experience. Acta Oncologica, 58, 1056-1061.
https://pubmed.ncbi.nlm.nih.gov/30938249
[15]
Souchek, J.J., Davis, A.L., Hill, T.K., et al. (2017) Combination Treatment with Orlistat-Containing Nanoparticles and Taxanes Is Synergistic and Enhances Microtubule Stability in Taxane-Resistant Prostate Cancer Cells. Molecular Cancer Therapeutics, 16, 1819-1830. https://pubmed.ncbi.nlm.nih.gov/28615298
[16]
Bakouny, Z., Paciotti, M., Schmidt, A.L., et al. (2021) Cancer Screening Tests and Cancer Diagnoses during the COVID-19 Pandemic. JAMA, 7, 458-460.
https://jamanetwork.com/journals/jamaoncology/fullarticle/2774867
[17]
World Bank. Life Expectancy at Birth, Total (Years)—Canada. Worldbank.org.
https://data.worldbank.org/indicator/SP.DYN.LE00.IN?locations=CA
[18]
Ochalek, J.M.L., Scott, J.R. and Philip, C.K. (2018) Assessing Health Opportunity Costs for the Canadian Health Care Systems—Research Database. The University of York, York.
https://pure.york.ac.uk/portal/en/publications/assessing-health-opportunity-costs-for-the-canadian-health-care-systems(09e94fda-62ba-422a-8d50-6d61070b2d24).html
[19]
Goffin, J.R., Flanagan, W.M., Miller, A.B., et al. (2016) Biennial Lung Cancer Screening in Canada with Smoking Cessation—Outcomes and Cost-Effectiveness. Lung Cancer, 101, 98-103. https://pubmed.ncbi.nlm.nih.gov/27794416
[20]
Zappa, C. and Mousa, S.A. (2016) Non-Small Cell Lung Cancer: Current Treatment and Future Advances. Translational Lung Cancer Research, 5, 288-300.
https://pubmed.ncbi.nlm.nih.gov/27413711
[21]
Song, M., Hildesheim, A. and Shiels, M.S. (2020) Premature Years of Life Lost Due to Cancer in the United States in 2017. Cancer Epidemiology, Biomarkers & Prevention, 29, 2591-2598. https://pubmed.ncbi.nlm.nih.gov/33187970
[22]
Maringe, C., Spicer, J., Morris, M., et al. (2020) The Impact of the COVID-19 Pandemic on Cancer Deaths Due to Delays in Diagnosis in England, UK: A National, Population-Based, Modelling Study. The Lancet Oncology, 21, 1023-1034.
https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(20)30388-0/fulltext
[23]
Moraliyage, H., De Silva, D., Ranasinghe, W., et al. (2021) Cancer in Lockdown: Impact of the COVID-19 Pandemic on Patients with Cancer. Oncologist, 26, e342-e344.
https://pubmed.ncbi.nlm.nih.gov/33210442
[24]
Gomez, D.R., Liao, K.-P., Swisher, S.G., et al. (2015) Time to Treatment as a Quality Metric in Lung Cancer: Staging Studies, Time to Treatment, and Patient Survival. Radiotherapy and Oncology, 115, 257-263.
https://pubmed.ncbi.nlm.nih.gov/26013292
[25]
Christensen, N.L., Jekunen, A., Heinonen, S., et al. (2017) Lung Cancer Guidelines in Sweden, Denmark, Norway and Finland: A Comparison. Acta Oncologica, 56, 943-948.
https://pubmed.ncbi.nlm.nih.gov/28418710
[26]
Ponholzer, F., Kroepfl, V., Ng, C., et al. (2021) Delay to Surgical Treatment in Lung Cancer Patients and Its Impact on Survival in a Video-Assisted Thoracoscopic Lobectomy Cohort. Scientific Reports, 11, Article No. 4914.
https://www.nature.com/articles/s41598-021-84162-4
[27]
COVIDSurg Collaborative (2020) Elective Surgery Cancellations Due to the COVID-19 Pandemic: Global Predictive Modelling to Inform Surgical Recovery Plans: Elective Surgery during the SARS-CoV-2 Pandemic. British Journal of Surgery, 107, 1440-1449. https://pubmed.ncbi.nlm.nih.gov/32395848
[28]
National Cancer Institute’s PROSPR Consortium, Corley, D.A., Sedki, M., et al. (2021) Cancer Screening during the Coronavirus Disease-2019 Pandemic: A Perspective from the National Cancer Institute’s PROSPR Consortium. Gastroenterology, 160, 999-1002. https://pubmed.ncbi.nlm.nih.gov/33096099
[29]
Pearce, J. (2010) Canada vs United States: How Canada Is so Much Better than America. Folklore Publishing, Edmonton.
https://versuscom/en/canada-vs-united-states
[30]
The Cancer Atlas (2022) Northern America.
https://canceratlas.cancer.org/the-burden/northern-america
[31]
Vinod, S.K., Chandra, A., Berthelsen, A., et al. (2017) Does Timeliness of Care in Non-Small Cell Lung Cancer Impact on Survival? Lung Cancer, 112, 16-24.
https://pubmed.ncbi.nlm.nih.gov/29191589
[32]
Eastman, B., Meaney, C., Przedborski, M., et al. (2021) Modeling the Impact of Public Response on the COVID-19 Pandemic in Ontario. PLOS ONE, 16, e0249456.
https://doi.org/10.1371/journal.pone.0249456
