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新冠疫情爆发背后的隐藏曲线:癌症患者治疗启动延迟的影响,以及如何减轻死亡的额外风险——头颈部癌症模型。

The hidden curve behind COVID-19 outbreak: the impact of delay in treatment initiation in cancer patients and how to mitigate the additional risk of dying-the head and neck cancer model.

机构信息

Department of Head and Neck Surgery, Instituto Do Cancer Do Estado de São Paulo (ICESP), University of São Paulo Medical School, and Faculdade Israelita de Ciências da Saúde Albert Einstein Medical School, Enéas de Carvalho Aguiar avenue, 255, 8th floor, room 8174, Sao Paulo, SP, 05403-000, Brazil.

Instituto Tecnológico de Aeronáutica (ITA), São José dos Campos, Brazil.

出版信息

Cancer Causes Control. 2021 May;32(5):459-471. doi: 10.1007/s10552-021-01411-7. Epub 2021 Mar 11.

Abstract

PURPOSE

The rapid spread of the SARS-CoV-2 pandemic around the world caused most healthcare services to turn substantial attention to treatment of these patients and also to alter the structure of healthcare systems to address an infectious disease. As a result, many cancer patients had their treatment deferred during the pandemic, increasing the time-to-treatment initiation, the number of untreated patients (which will alter the dynamics of healthcare delivery in the post-pandemic era) and increasing their risk of death. Hence, we analyzed the impact on global cancer mortality considering the decline in oncology care during the COVID-19 outbreak using head and neck cancer, a known time-dependent disease, as a model.

METHODS

An online practical tool capable of predicting the risk of cancer patients dying due to the COVID-19 outbreak and also useful for mitigation strategies after the peak of the pandemic has been developed, based on a mathematical model. The scenarios were estimated by information of 15 oncological services worldwide, given a perspective from the five continents and also some simulations were conducted at world demographic data.

RESULTS

The model demonstrates that the more that cancer care was maintained during the outbreak and also the more it is increased during the mitigation period, the shorter will be the recovery, lessening the additional risk of dying due to time-to-treatment initiation.

CONCLUSIONS

This impact of COVID-19 pandemic on cancer patients is inevitable, but it is possible to minimize it with an effort measured by the proposed model.

摘要

目的

SARS-CoV-2 疫情在全球范围内迅速蔓延,导致大多数医疗服务机构将大量注意力转向治疗这些患者,并改变医疗体系结构以应对传染病。因此,许多癌症患者在疫情期间推迟了治疗,增加了治疗开始的时间、未治疗患者的数量(这将改变疫情后医疗服务的动态),并增加了他们的死亡风险。因此,我们分析了考虑到 COVID-19 爆发期间肿瘤治疗减少对全球癌症死亡率的影响,使用头颈部癌症作为一种已知的时间依赖性疾病的模型。

方法

根据数学模型,我们开发了一种在线实用工具,能够预测因 COVID-19 爆发而导致癌症患者死亡的风险,并且在疫情高峰期过后对于缓解策略也很有用。通过来自全球 15 个肿瘤服务机构的信息,基于五个大陆的视角对这些方案进行了估计,并且还根据世界人口数据进行了一些模拟。

结果

该模型表明,在疫情期间维持肿瘤治疗的程度越高,以及在缓解期间增加治疗的程度越高,恢复时间就越短,由于治疗开始时间的延迟而导致额外死亡的风险就越低。

结论

COVID-19 大流行对癌症患者的影响是不可避免的,但通过所提出的模型进行的努力,可以将其最小化。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ccfb/7950430/068cf41165df/10552_2021_1411_Fig1_HTML.jpg

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