|dc.description.abstract||Background: Cancer diagnostics and surgery have been disrupted by the response of health care services to the
coronavirus disease 2019 (COVID-19) pandemic. Progression of cancers during delay will impact on patients’ longterm survival.
Patients and methods: We generated per-day hazard ratios of cancer progression from observational studies and
applied these to age-specific, stage-specific cancer survival for England 2013e2017. We modelled per-patient delay
of 3 and 6 months and periods of disruption of 1 and 2 years. Using health care resource costing, we contextualise
attributable lives saved and life-years gained (LYGs) from cancer surgery to equivalent volumes of COVID-19
Results: Per year, 94 912 resections for major cancers result in 80 406 long-term survivors and 1 717 051 LYGs. Perpatient delay of 3/6 months would cause attributable death of 4755/10 760 of these individuals with loss of 92
214/208 275 life-years, respectively. For cancer surgery, average LYGs per patient are 18.1 under standard
conditions and 17.1/15.9 with a delay of 3/6 months (an average loss of 0.97/2.19 LYGs per patient), respectively.
Taking into account health care resource units (HCRUs), surgery results on average per patient in 2.25 resourceadjusted life-years gained (RALYGs) under standard conditions and 2.12/1.97 RALYGs following delay of 3/6 months.
For 94 912 hospital COVID-19 admissions, there are 482 022 LYGs requiring 1 052 949 HCRUs. Hospitalisation of
community-acquired COVID-19 patients yields on average per patient 5.08 LYG and 0.46 RALYGs.
Conclusions: Modest delays in surgery for cancer incur significant impact on survival. Delay of 3/6 months in surgery for
incident cancers would mitigate 19%/43% of LYGs, respectively, by hospitalisation of an equivalent volume of
admissions for community-acquired COVID-19. This rises to 26%/59%, respectively, when considering RALYGs. To
avoid a downstream public health crisis of avoidable cancer deaths, cancer diagnostic and surgical pathways must
be maintained at normal throughput, with rapid attention to any backlog already accrued.
Key words: COVID-19, delay, diagnostics, oncology, survival||spa