Collateral damage: the impact on outcomes from cancer surgery of the COVID-19 pandemic

A. Sud, M. E. Jones, J. Broggio, C. Loveday, B. Torr, A. Garrett, D. L. Nicol, S. Jhanji, S. A. Boyce, F. Gronthoud, P. Ward, J. M. Handy, N. Yousaf, J. Larkin, Y. E. Suh, S. Scott, P. D.P. Pharoah, C. Swanton, C. Abbosh, M. WilliamsGeorgios Lyratzopoulos, R. Houlston, C. Turnbull*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

256 Citations (Scopus)


Background: Cancer diagnostics and surgery have been disrupted by the response of health care services to the coronavirus disease 2019 (COVID-19) pandemic. Progression of cancers during delay will impact on patients' long-term survival. 

Patients and methods: We generated per-day hazard ratios of cancer progression from observational studies and applied these to age-specific, stage-specific cancer survival for England 2013–2017. We modelled per-patient delay of 3 and 6 months and periods of disruption of 1 and 2 years. Using health care resource costing, we contextualise attributable lives saved and life-years gained (LYGs) from cancer surgery to equivalent volumes of COVID-19 hospitalisations. 

Results: Per year, 94 912 resections for major cancers result in 80 406 long-term survivors and 1 717 051 LYGs. Per-patient delay of 3/6 months would cause attributable death of 4755/10 760 of these individuals with loss of 92 214/208 275 life-years, respectively. For cancer surgery, average LYGs per patient are 18.1 under standard conditions and 17.1/15.9 with a delay of 3/6 months (an average loss of 0.97/2.19 LYGs per patient), respectively. Taking into account health care resource units (HCRUs), surgery results on average per patient in 2.25 resource-adjusted life-years gained (RALYGs) under standard conditions and 2.12/1.97 RALYGs following delay of 3/6 months. For 94 912 hospital COVID-19 admissions, there are 482 022 LYGs requiring 1 052 949 HCRUs. Hospitalisation of community-acquired COVID-19 patients yields on average per patient 5.08 LYG and 0.46 RALYGs. 

Conclusions: Modest delays in surgery for cancer incur significant impact on survival. Delay of 3/6 months in surgery for incident cancers would mitigate 19%/43% of LYGs, respectively, by hospitalisation of an equivalent volume of admissions for community-acquired COVID-19. This rises to 26%/59%, respectively, when considering RALYGs. To avoid a downstream public health crisis of avoidable cancer deaths, cancer diagnostic and surgical pathways must be maintained at normal throughput, with rapid attention to any backlog already accrued.

Original languageEnglish
Pages (from-to)1065-1074
Number of pages10
JournalAnnals of Oncology
Issue number8
Early online date19 May 2020
Publication statusPublished - 28 Jul 2020

Bibliographical note

Funding Information: CT, RSH and MEJ are supported by The Institute of Cancer
Research. MEJ additionally received funding from Breast Cancer Now. BT and AG are supported by Cancer Research UK [grant number C61296/A27223]. CL is supported by and CT additionally receives funding from The Movember Foundation. RSH is supported by Cancer Research UK [grant number C1298/A8362] and Bobby Moore Fund for Cancer Research UK. AS is in receipt of an Academic Clinical Lectureship from National Institute for Health Research (NIHR) and Biomedical Research Centre (BRC) post-doctoral support. This is a summary of independent research supported by the NIHR BRC at the Royal Marsden NHS Foundation Trust and Institute of Cancer Research. The views
expressed are those of the authors and not necessarily those of the NHS, NIHR or the Department of Health. GL is supported by a Cancer Research UK Advanced Clinician Scientist Fellowship Award [grant number C18081/A18180] and is an Associate Director of the multi-institutional CanTest Collaborative funded by Cancer Research UK [grant number C8640/A23385].

Open Access: This is an open access article under the CC BY-NC-ND license (

Publisher Copyright: © 2020 The Author(s). Published by Elsevier Ltd on behalf of European Society for Medical Oncology

Citation: A. Sud, M.E. Jones, J. Broggio, C. Loveday, B. Torr, A. Garrett, D.L. Nicol, S. Jhanji, S.A. Boyce, F. Gronthoud, P. Ward, J.M. Handy, N. Yousaf, J. Larkin, Y-E. Suh, S. Scott, P.D.P. Pharoah, C. Swanton, C. Abbosh, M. Williams, G. Lyratzopoulos, R. Houlston, C. Turnbull, Collateral damage: the impact on outcomes from cancer surgery of the COVID-19 pandemic, Annals of Oncology,
Volume 31, Issue 8, 2020, Pages 1065-1074, ISSN 0923-7534.



  • COVID-19
  • delay
  • diagnostics
  • oncology
  • survival


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