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Abstract
Objective To investigate childhood, teenage and young adult cancer diagnostic pathways during the first wave of the COVID-19 pandemic in England.
Design Population-based cohort study.
Setting and participants QResearch, a nationally representative primary care database, linked to hospital admission, mortality and cancer registry data, was used to identify childhood, teenage and young adult cancers (0–24 years) diagnosed between 1 January 2017 and 15 August 2020.
Main outcomes Main outcomes of interest were: (1) number of incident cancer diagnoses per month, (2) diagnostic, treatment time intervals and (3) cancer-related intensive care admissions.
Results 2607 childhood, teenage and young adult cancers were diagnosed from 1 January 2017 to 15 August 2020; 380 were diagnosed during the pandemic period. Overall, 17% (95% CI −28.0% to −4.0%) reduction in the incidence rate ratio of cancers was observed during the pandemic. Specific decreases were seen for central nervous system tumour (−38% (95% CI −52% to −21%)) and lymphoma (−28% (95% CI −45% to −5%)) diagnoses. Additionally, childhood cancers diagnosed during the pandemic were significantly more likely to have intensive care admissions (adjusted OR 2.2 (95% CI 1.33 to 3.47)). Median time-to-diagnosis did not significantly differ across periods (+4.5 days (95% CI −20.5 to +29.5)), while median time-to-treatment was shorter during the pandemic (−0.7 days (95% CI −1.1 to −0.3)).
Conclusions Collectively, our findings of a significant reduction in cancer diagnoses and increase in intensive care admissions provide initial insight into the changes that occurred to childhood, teenage and young adult cancer diagnostic pathways during the first wave of the pandemic.
- Covid-19
- Epidemiology
Data availability statement
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Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information.
Footnotes
Contributors DS, AH and JH-C contributed to study concept. DS, JH-C and JO contributed to the study design. DS led the data acquisition, data analysis and drafting of the manuscript. All authors contributed to the interpretation of the data and critical revision of the manuscript for important intellectual content. DS was supervised by JH-C and AH. DS and JH-C had full access to all the data in the study and act as guarantors, take responsibility for the integrity of the data and the accuracy of the data analysis.
Funding This study was funded by the University of Oxford COVID-19 Research Response Fund (0009397).
Disclaimer The funding body had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Competing interests JH-C reports grants from the National Institute for Health Research Biomedical Research Centre, Oxford, grants from John Fell Oxford University Press Research Fund, grants from Cancer Research UK (CR-UK) (grant number C5255/A18085), through the Cancer Research UK Oxford Centre, grants from the Oxford Wellcome Institutional Strategic Support Fund (204826/Z/16/Z), during the conduct of the study. JH-C is an unpaid director of QResearch, a not-for-profit organisation which is a partnership between the University of Oxford and EMIS Health that supplies the QResearch Database used for this work. JH-C is chair of the NERVTAG subgroup on risk stratification and a member of SAGE groups on data and ethnicity. JH-C is a founder and shareholder of ClinRisk and was its medical director until 31 May 2019. ClinRisk produces open and closed source software to implement clinical risk algorithms (outside this work) into clinical computer systems. DS, AH and JO declare no conflicts of interest.
Provenance and peer review Not commissioned; externally peer reviewed.
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