使用中断时间序列分析测量COVID-19对加拿大马尼托巴省诊断为癌症的个体治疗时间的影响

IF 2 Q3 HEALTH POLICY & SERVICES

Journal of Cancer Policy Pub Date : 2025-03-11 DOI:10.1016/j.jcpo.2025.100576

Pascal Lambert , Katie Galloway , Allison Feely , Oliver Bucher , Piotr Czaykowski , Pamela Hebbard , Julian O. Kim , Marshall Pitz , Harminder Singh , Grace Musto , Kathleen M. Decker

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引用次数: 0

摘要

背景：治疗延误可导致癌症发病率和死亡率增加。很多人担心，新冠肺炎疫情导致癌症治疗延误。一些研究调查了这个问题，但有严重的局限性。我们进行了一项研究，解决了许多这些局限性，并评估了大流行期间加拿大马尼托巴省诊断为癌症的个体在首次治疗、手术、全身治疗和放射治疗（RT）方面的变化。方法采用以人群为基础的准实验横断面研究，采用中断时间序列分析，研究在2019年1月- 2019年9月和2020年4月- 2022年12月COVID-19大流行之前和之后首次治疗的时间（表示为占竞争死亡风险的治疗率）。结果与没有COVID-19的反事实情景相比，在COVID-19期间，任何癌症部位的首次治疗均未明显延迟。确诊为乳腺癌、结肠癌、内分泌癌或头颈癌的患者在确诊后90天内接受首次治疗的时间明显早于反事实期间。在检查诊断一年内的治疗类型时，诊断为乳腺癌的个体在2020年4月至6月期间接受手术的时间明显晚于2020年4月至2021年9月期间接受全身治疗的时间明显早于2020年4月。从2020年4月到2021年6月，结肠癌患者的手术时间明显提前，直肠癌患者的RT时间明显晚于2021年1月至6月。结论：尽管受到COVID-19的严重影响，马尼托巴省的癌症护理系统能够优先考虑被诊断患有癌症的个体并修改治疗方式，从而在2020年4月至2022年12月期间首次治疗没有明显延误。政策概述评估长期生存状况是很重要的，如果不加以改变，继续使用在大流行中首次使用的战略可能是合理的。

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Measuring the impact of COVID-19 on time to treatment for individuals diagnosed with cancer in Manitoba, Canada using an interrupted time series analysis

Background

Delays in treatment can lead to increases in cancer morbidity and mortality. There were many concerns that the COVID-19 pandemic led to delays in cancer treatment. Several studies have examined this issue but with serious limitations. We conducted a study that addressed many of these limitations and evaluated changes in first treatment, surgery, systemic therapy, and radiation therapy (RT) during the pandemic for individuals diagnosed with cancer in Manitoba, Canada.

Methods

A population-based, quasi-experimental cross-sectional study with an interrupted time series analysis was used to examine time to first treatment (expressed as treatment rates accounting for the competing risk of death) before (January 2015–September 2019) and after (April 2020–December 2022) the COVID-19 pandemic.

Results

When compared to the counterfactual scenario without COVID-19, first treatments were not received significantly later during the COVID-19 period for any cancer site. Individuals diagnosed with breast, colon, endocrine, or head and neck cancer had their first treatment within 90 days of diagnosis significantly sooner when comparing the COVID-19 period to the counterfactual. When examining type of treatment within one year of diagnosis, individuals diagnosed with breast cancer had surgery significantly later from April to June 2020 and systemic therapy significantly sooner from April 2020 to September 2021. Individuals diagnosed with colon cancer had surgery significantly sooner from April 2020 to June 2021 and individuals diagnosed with rectal cancer had RT significantly later from January to June 2021.

Conclusions

Although significantly impacted by COVID-19, the cancer care system in Manitoba was able to prioritize individuals diagnosed with cancer and modify treatment modalities resulting in no significant delays in first treatment between April 2020 and December 2022.