We investigated the impact of the COVID-19 pandemic on cancer surgery and cancer mortality in England, including whether certain groups of patients (such as those defined by age, deprivation, ethnicity, and geography) were affected differently.
The analysis examined trends in cancer surgery activity, place of death, and in-hospital mortality rates before and during the pandemic to understand whether existing inequalities in cancer care widened over this period.
The numbers of patients having cancer surgery fell sharply at the start of the pandemic across almost all demographic groups and cancer types. The largest reductions for all cancers combined were seen in White patients (−42.6%) and Asian or Asian British patients (−44.6%).
Most groups saw a recovery in cancer surgery activity, suggesting that services rebounded as the pandemic progressed. Overall, the recovery period did not appear to substantially widen existing inequalities in access to cancer surgery.
Some inequalities remained, particularly for lung cancer surgery. During the recovery period, patients having surgery increased more in the least deprived areas (+42.0%) than in the most deprived areas (+27.6%).
Age-related differences were observed. For example, women aged 40-49 experienced sustained reductions in cancer surgery during both the initial pandemic period and the recovery period, particularly for breast cancer.
Patterns of cancer mortality changed markedly. There was a large increase in cancer deaths occurring at home (+51.5%) and a decrease in hospital deaths (−35.0%) at the start of the pandemic, reflecting changes in healthcare delivery and patient care during this period. In the recovery period, deaths at home continued to be higher compared to pre-pandemic levels.
In-hospital mortality rates increased at the start of the pandemic across cancer types, before subsequently falling. Mortality rates remained consistently higher among the most deprived groups than the least deprived throughout the period studied.
These findings show the scale of the disruption to cancer services caused by the COVID-19 pandemic. The impact of the COVID-19 pandemic on patients and the health service was profound and sustained.
The findings also highlight the groups who were disproportionately affected and may need additional support. However, it is difficult to understand the extent to which any variation in access to cancer services is unwarranted. It highlights the need for continual monitoring of the situation and further research into the impact of delayed diagnosis and treatment.
Read the report in fullCancer Research UK and Telstra Health UK.
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