Abstract LB076: Association between regional COVID-19 hospitalizations and treatment delays amongst confirmed cancer patients in England, UK
Authors: Fox Louis , Aggarwal Ajay , Sullivan Richard , Haire Kate , Purushotham Arnie , Spicer James , Papa Sophie , Rigg Anne , Dolly Saoirse , Van Hemelrijck Mieke 
Published: July 2021

Abstract
Introduction: The COVID-19 pandemic has had substantial impacts on cancer services. National Cancer Waiting Times (CWT) targets in England stipulate that individuals referred from primary care for suspected cancer must receive treatment for any confirmed cancer within 62 days of referral. This analysis aimed to broadly quantify the association between COVID-19 hospitalizations by England region, and the proportion of confirmed cancer patients breaching the 62-day target in that region a month later, during the first wave of COVID-19 in England.
Methods: CWT data were retrospectively obtained from all 135 clinical subregions of the National Health Service (NHS) in England, for the 6-month period from April to September 2020 inclusive. Subregion data were then grouped by each of the seven regions of England: London; South East England; South West England; East of England; the Midlands; North West England; and North East England & Yorkshire. The mean number of monthly cases of confirmed cancer that waited more than 62 days from referral for their treatment (CWT breaches) was calculated amongst subregions within each region, inclusive of all cancer types. These 62-day primary care referrals represent around 73% of all treated cancers. These data were entered into linear regression models for each region, alongside daily UK Government data on numbers of patients in hospital with suspected COVID-19 within each region, with a 30-day lag applied (e.g. CWT breaches that occurred in June were plotted against COVID-19 hospitalization data from May).
Results: The regression models showed that regional COVID-19 hospitalizations were significantly positively associated with 62-day CWT breaches the following month, for all regions except for London (all significant at the p&lt;0.01 level). The association also approached significance for the London region (p=0.053). Adjustments for the size of each region produced standardised estimates of the average number of COVID-19 hospitalizations per subregion associated with a 1% absolute decrease in the proportion of 62-day referrals meeting the target: 15 in South East England, 20 in South West England, 17 in the East of England, 17 in the Midlands, 17 in the North West of England, 19 in the North East of England & Yorkshire, and 35 in London. Regional findings for London should be interpreted with caution, due to its characteristics as both the epicenter of the first wave, and as an area with high density of hospitals and cancer centers.
Conclusion: Higher rates of regional hospitalizations for suspected COVID-19 during England's initial wave of SARS-CoV-2 were associated with increased delays to cancer treatments across most England regions. It should be noted that CWT breaches do not necessarily translate directly into clinical harm, due to clinical risk prioritization strategies that were deployed during the initial wave of COVID-19.
Citation Format: Louis Fox, Ajay Aggarwal, Richard Sullivan, Kate Haire, Arnie Purushotham, James Spicer, Sophie Papa, Anne Rigg, Saoirse Dolly, Mieke Van Hemelrijck. Association between regional COVID-19 hospitalizations and treatment delays amongst confirmed cancer patients in England, UK [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr LB076.