Health Data and Assessment Department, Survey Data Science and Assessment Division, National Cancer Institute, Boulogne-Billancourt, France.
Care Paths Organization Department, Public Health Division, National Cancer Institute, Boulogne-Billancourt, France.
JAMA Netw Open. 2023 Jan 3;6(1):e2253204. doi: 10.1001/jamanetworkopen.2022.53204.
IMPORTANCE: COVID-19 has had a major effect on health care activities, especially surgery. At first, comparisons were proposed using 2019 activities as the highest standard. However, while such an approach might have been suitable during the first months of the pandemic, this might no longer be the case for a longer period. OBJECTIVE: To examine approaches that may better assess the use of cancer surgeries. DESIGN, SETTING, AND PARTICIPANTS: In a cross-sectional design, the nationwide French hospital facility data (Medicalised Information System Program) were used to assess cancer surgery for 6 cancer site categories in adults from January 1, 2010, to December 31, 2021. EXPOSURE: Estimated cancer surgery activity during the COVID-19 pandemic. MAIN OUTCOMES AND MEASURES: Three models were proposed to assess the expected number of surgical procedures between 2020 and 2021 and make a comparison with those observed in earlier years. RESULTS: In France, cancer removal surgeries account for approximately 7000 hospitalizations per year for liver cancer; 4000 for pancreatic cancer; 7700 for ovarian cancer; 1300 for esophagus cancer; 23 000 for ear, nose, and throat (ENT) cancer; 78 000 for breast cancer; and 16 600 for thoracic cancers. For most cancer sites, the number of surgical procedures increased from 2010 to 2019: liver, 14%; pancreas, 38%; ovary, 14%; esophagus, 18%; breast, 8%; and thoracic, 29%. Assuming stability, these values underestimate the gap in activity observed in 2020-2021. For other procedures, a decrease was observed: stomach, -10%, and ENT, -6%. Assuming stability, these values overestimate the gap in activity observed in 2020-2021. At the end of 2021, according to the model, the gap in activity observed in 2020-2021 was estimated at between -1.4% and 1.7% for breast, -6.6% and -7.3% for thoracic, -3.1% and -2.5% for ovarian, -4.2% and -1.7% for pancreas, -6.7% and 5.9% for stomach, and -13.0% and -13.9% for esophageal cancers. For ENT, liver, and urologic cancers, because the trend was different before and after 2015, it was necessary to opt for modeling using only the most recent period. The cumulative gap in activity observed in 2020-2021 was estimated at -1.0% for ENT cancers, -5.3% for liver cancers, and -2.9% for urologic cancers. CONCLUSIONS AND RELEVANCE: The findings of this study suggest that short- and medium-term trends must be considered to estimate COVID-19 cancer surgery activities. Breast cancer is the site for which the activity showed the smallest decrease during the pandemic, with almost full recovery in 2021.
重要性:新冠疫情对医疗活动产生了重大影响,尤其是手术。最初,有人提议使用 2019 年的活动作为最高标准进行比较。然而,这种方法在大流行的最初几个月可能是合适的,但在更长的时间内可能不再适用。
目的:研究更好的评估癌症手术使用情况的方法。
设计、设置和参与者:采用横断面设计,利用法国全国性医院设施数据(医疗信息系统项目),评估 2010 年 1 月 1 日至 2021 年 12 月 31 日期间成人 6 个癌症部位的癌症手术情况。
暴露:新冠疫情期间癌症手术活动的估计情况。
主要结果和措施:提出了三种模型来评估 2020 年至 2021 年期间预计的手术数量,并与前几年的实际情况进行比较。
结果:在法国,肝癌每年约有 7000 例手术切除;胰腺癌 4000 例;卵巢癌 7700 例;食管癌 1300 例;耳鼻喉癌(ENT)23000 例;乳腺癌 78000 例;胸癌 16600 例。对于大多数癌症部位,2010 年至 2019 年期间手术数量有所增加:肝脏增加 14%;胰腺增加 38%;卵巢增加 14%;食管增加 18%;乳房增加 8%;胸部增加 29%。假设保持稳定,这些数值低估了 2020-2021 年观察到的活动差距。对于其他手术,观察到下降:胃,-10%,耳鼻喉科,-6%。假设保持稳定,这些数值高估了 2020-2021 年观察到的活动差距。到 2021 年底,根据模型,2020-2021 年观察到的活动差距估计为:乳房,-1.4%至 1.7%;胸部,-6.6%至-7.3%;卵巢,-3.1%至-2.5%;胰腺,-4.2%至-1.7%;胃,-6.7%至 5.9%;食管,-13.0%至-13.9%。对于 ENT、肝脏和泌尿科癌症,由于 2015 年前后的趋势不同,因此必须选择仅使用最近时期进行建模。2020-2021 年期间观察到的累计活动差距估计为:ENT 癌症,-1.0%;肝癌,-5.3%;泌尿科癌症,-2.9%。
结论和相关性:本研究结果表明,必须考虑短期和中期趋势来估计新冠疫情期间的癌症手术活动。乳腺癌是疫情期间活动下降最小的部位,2021 年几乎完全恢复。
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