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This rapid viral spread, unencumbered by an effective treatment or vaccine, required wise health care resource utilization decisions. Consequently, many centers throughout the world have decided to delay elective surgical procedures including those for cancer to avoid health care system exhaustion.
Our team at Mayo Clinic derived results based on the American College of Surgeons National Cancer Database, which concluded that delaying elective surgery for patients with stage I to III colon cancer was independently associated with the decrease in the 5-year overall survival.
30,937 deaths (26%) occurred among 118,504 patients with colon cancer during a 5-year follow-up. Delaying the surgical resection for patients with stage I to III colon cancer was associated with an increase in the mortality rate within the 5 years of follow-up (25% mortality rate when surgery was performed within 1 month of diagnosis vs 37% after a 4-month delay). This increase in death from cancer was already apparent within the first year (Figure), highlighting the urgency and impact of our nation’s health care decisions.
In the United States, we expect to have 104,610 new cases of colon cancer in 2020 with about 83,688 patients having stage I to III colon cancer.
This incidence will result in 20,922 (25%) expected deaths within 5 years of surgery if performed within 30 days of diagnosis (Figure). Unfortunately, if colon cancer surgery is delayed for more than 4 months, it has the potential to result in the deaths of 30,965 within the same 5-year period. This potential tragic outcome may result in an additional loss of 10,043 Americans over 5 years (Figure). This model may be an underestimate, as some patients may die before ever undergoing surgical treatment and are not counted. Moreover, this estimate only represents the human tragedy for colon cancer, as the impact of all cancer would be expected to be much larger. Alternative assumptions according to the period of delay in surgery are presented in the Figure.
Therefore, political and health care leaders must recognize the potential negative impacts on current patients as they address the pandemic before us. Alternative treatments (chemotherapy, immunotherapy, radiotherapy), a national network that would enable referral of patients for surgery in less impacted cities, and screening patients before surgery must be considered to reduce this potential increase in mortality due to the delay in surgical treatment. Furthermore, patients with cancer represent a more vulnerable population and appear to have a higher rate of severe complications after infection with COVID-19. This dilemma, along with many other considerations, puts into focus the importance of decision making regarding the optimal choice for this vulnerable population.
Centers for Disease Control and Prevention
Coronavirus disease 2019 (COVID-19): cases in the U.S. Centers for Disease Control and Prevention website.