Public Health Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh EH12 9EB, United Kingdom.
Public Health Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh EH12 9EB, United Kingdom.
J Cancer Policy. 2024 Dec;42:100502. doi: 10.1016/j.jcpo.2024.100502. Epub 2024 Sep 5.
The COVID-19 pandemic disrupted normal pathways to cancer diagnosis, particularly for screening and non-acute symptomatic patients. While reductions in overall cancer diagnoses have been reported elsewhere, any differential effects on emergency presentations, which are associated with poorer outcomes, have not been described.
Cross-sectional descriptive study from 2015 to 2021, based on International Cancer Benchmarking Partnership methods, where emergency route to diagnosis is defined as presenting as an emergency admission in the 30 days prior to cancer incidence date. Acute hospital records and cancer registrations were individually linked. Includes all individuals with a new diagnosis of specific cancers on the national cancer registry.
All cancers included showed reductions in non-emergency diagnoses in 2020, with varying recovery in 2021. The largest reductions in non-emergency diagnoses of about a third were for colorectal and cervical cancers in 2020. Non-emergency diagnoses of prostate cancer remained lower but upper GI higher in 2021. Emergency routes to diagnosis were significantly higher in 2020 for breast, cervical, colorectal and upper GI cancers and were higher in 2021 for breast and cervical cancers. The absolute magnitude of reductions in non-emergency diagnoses was greater than any increases in emergency diagnoses.
In 2020, there were large reductions in numbers of cancers diagnosed through non-emergency pathways in Scotland, while those diagnosed via emergency routes fell only for prostate cancer. Some effects persisted or emerged through 2021. It is likely that opportunities to diagnose cancers in a favourable, elective manner have been lost. Further work is needed to describe outcomes among these patients.
COVID-19 大流行扰乱了癌症诊断的正常途径，特别是对筛查和非急性症状患者而言。虽然其他地方已经报告了癌症诊断总数的减少，但尚未描述对急诊就诊的任何差异影响，急诊就诊与较差的预后相关。
这是一项基于国际癌症基准合作计划方法的 2015 年至 2021 年的横断面描述性研究，其中将诊断的急诊途径定义为在癌症发病日期前 30 天内作为急诊入院就诊。急性医院记录和癌症登记单独关联。包括国家癌症登记处新诊断出的所有特定癌症患者。
所有癌症的非急诊诊断在 2020 年均减少，2021 年有所恢复。2020 年，结直肠癌和宫颈癌的非急诊诊断减少了约三分之一，降幅最大。前列腺癌的非急诊诊断仍较低，但 2021 年上消化道癌的非急诊诊断较高。2020 年，乳腺癌、宫颈癌、结直肠癌和上消化道癌的急诊途径明显更高，2021 年乳腺癌和宫颈癌的急诊途径更高。非急诊诊断减少的绝对幅度大于急诊诊断的任何增加。
2020 年，苏格兰通过非急诊途径诊断的癌症数量大幅减少，而通过急诊途径诊断的癌症数量仅在前列腺癌中下降。一些影响在 2021 年仍在持续或出现。可能已经失去了以有利、选择性方式诊断癌症的机会。需要进一步工作来描述这些患者的结局。
