Gustave-Roussy models the impact of Covid-19 on the management of cancers.
November 11, 2020
Cécile Bour, MD
Patients' concern about possible coronavirus contamination in hospital, especially in oncology, leads them to delay their visits to health centers for treatment.
Researchers from Gustave-Roussy in Villejuif (Val-de-Marne) have carried out a study called "Grouvid", based on a mathematical simulation model to assess the impact of the Covid-19 pandemic on the organization of cancer care. The consequences in terms of prognosis and the possible excess mortality resulting from the delay in the management of patients diagnosed with cancer during the lockdown period are studied and evaluated in the present article.
This work carried out by researchers Aurelie Bardet1,2, Alderic Fraslin1,2, Matthieu Faron2,3, Isabelle Borget1,2, Lucile Ter-Minassian4, Jamila Marghadi5, Anne Aupérin1,2, Stefan Michiels1,2, Fabrice Barlesi6, Julia Bonastre1,2 was presented at the ESMO 2020 virtual congress by Aurélie Bardet (see PDF of the congress).
• 1 Biostatistics and Epidemiology Department, Gustave Roussy
• 2. Research team in statistical methodology Oncostat Inserm 1018, Univ. Paris-Saclay, Ligue against cancer
• 3. Visceral Oncological Surgery Department, Gustave Roussy
• 4. Department of statistics, Oxford University, Oxford, United-Kingdom
• 5. Medical Information Service, Gustave Roussy
• 6. Medical and Clinical Research Department, Gustave Roussy, Paris-Saclay University.
Content of the virtual conference, presentation of the study
This is a microsimulation model to assess the impact of SARS-CoV-2 on cancer prognosis, health care organization and management costs.
Evaluate the impact of the pandemic on non-covid cancer patients.
The aim is to establish a model based on the current data available from the Gustave Roussy center to model the individual pathways of patients.
The Covid-19 epidemic has led to a decrease in the number of patients managed during lockdown and a limitation of resources dedicated to cancer, with the closure of the marrow transplant unit, reduction of surgical intensive care beds, reduction in the number of operating rooms, reduction of chemotherapy and radiotherapy sessions.
1° Modification of patient flow - Treatment delays
- 13.4% of patients have a delay in treatment of more than 7 days, mainly patients with thyroid and breast cancer.
Median delay = 55 days, mainly due to patient inherent delay.
- 5.2% of patients have a treatment delay of more than 2 months
2° Changes in medical care
27% of confined patients see their care modified (mainly in breast cancer and gastrointestinal pathologies).
3° Hospital resources
Two resources are limiting:
- the availability of operating rooms (expected peak activity = mid-June)
- Chemotherapy (expected peak activity = mid-October with creation of waiting lines)
4° Results on cancer prognosis :
- 2.0% of patients present a major change in their prognosis of disease with
- 2.25% increase in 5-year cancer deaths, mainly liver, sarcoma and head and neck cancers => 49 additional deaths.
5° Sensitivity analysis of the average time to seek care attributable to patients
This is an estimate of the impact of a staggered and regular (uniform) return of patients (because of this staggering, the median delay in management is estimated at 3.4 months). :
2.4% of patients would present a major change in their prognosis, with a 4.60% increase in deaths at 5 years.
C-Key messages and conclusion
Based on a scenario in the context of the Institut Gustave Roussy :
- 2% of patients will present a major change in their prognosis
- 2% additional deaths at 5 years
There is still a great deal of uncertainty about future events and complex behaviours in order to assess the impact of a 2nd wave.
Comments by Cancer Rose
The Grouvid study suggests that delays in patient management, linked to the 1st wave of Covid-19, could be responsible for an excess of cancer mortality of 2 to 5%, 5 years after the start of management. These delays in management are due to 2 factors:
- the reluctance of patients to be treated for fear of contamination
- and a reduction in hospital care capacity.
In this study, there is no mention of screening, neither for breast cancer screening nor for any other screening.
Contrary to what has been suggested by the ARC Foundation [i] or Professor Kahn, President of the Cancer League [ii] [iii] [iv] [v] [vi] [vii] [viii], the Grouvid study does not provide any information about the potential benefits of reduced participation in screening.
It is already difficult to extrapolate results from a single institution to all France. Extrapolating them to estimate the impact of a decrease in screening is pure fantasy ... or a deliberate lie.
The victims? Women, who, encouraged to frequent medical offices during this period, are thus endangered and exposed by these propagandistic behaviors.
The media themselves, by lack of discernment and nuance, feed this anxiety-provoking and misleading climate.
On this subject read : https://cancer-rose.fr/en/2020/12/17/manipulation-of-information/