RT Journal Article SR Electronic T1 Estimated impact of the COVID-19 pandemic on cancer services and excess 1-year mortality in people with cancer and multimorbidity: near real-time data on cancer care, cancer deaths and a population-based cohort study JF BMJ Open JO BMJ Open FD British Medical Journal Publishing Group SP e043828 DO 10.1136/bmjopen-2020-043828 VO 10 IS 11 A1 Lai, Alvina G A1 Pasea, Laura A1 Banerjee, Amitava A1 Hall, Geoff A1 Denaxas, Spiros A1 Chang, Wai Hoong A1 Katsoulis, Michail A1 Williams, Bryan A1 Pillay, Deenan A1 Noursadeghi, Mahdad A1 Linch, David A1 Hughes, Derralynn A1 Forster, Martin D A1 Turnbull, Clare A1 Fitzpatrick, Natalie K A1 Boyd, Kathryn A1 Foster, Graham R A1 Enver, Tariq A1 Nafilyan, Vahe A1 Humberstone, Ben A1 Neal, Richard D A1 Cooper, Matt A1 Jones, Monica A1 Pritchard-Jones, Kathy A1 Sullivan, Richard A1 Davie, Charlie A1 Lawler, Mark A1 Hemingway, Harry YR 2020 UL http://bmjopen.bmj.com/content/10/11/e043828.abstract AB Objectives To estimate the impact of the COVID-19 pandemic on cancer care services and overall (direct and indirect) excess deaths in people with cancer.Methods We employed near real-time weekly data on cancer care to determine the adverse effect of the pandemic on cancer services. We also used these data, together with national death registrations until June 2020 to model deaths, in excess of background (pre-COVID-19) mortality, in people with cancer. Background mortality risks for 24 cancers with and without COVID-19-relevant comorbidities were obtained from population-based primary care cohort (Clinical Practice Research Datalink) on 3 862 012 adults in England.Results Declines in urgent referrals (median=−70.4%) and chemotherapy attendances (median=−41.5%) to a nadir (lowest point) in the pandemic were observed. By 31 May, these declines have only partially recovered; urgent referrals (median=−44.5%) and chemotherapy attendances (median=−31.2%). There were short-term excess death registrations for cancer (without COVID-19), with peak relative risk (RR) of 1.17 at week ending on 3 April. The peak RR for all-cause deaths was 2.1 from week ending on 17 April. Based on these findings and recent literature, we modelled 40% and 80% of cancer patients being affected by the pandemic in the long-term. At 40% affected, we estimated 1-year total (direct and indirect) excess deaths in people with cancer as between 7165 and 17 910, using RRs of 1.2 and 1.5, respectively, where 78% of excess deaths occured in patients with ≥1 comorbidity.Conclusions Dramatic reductions were detected in the demand for, and supply of, cancer services which have not fully recovered with lockdown easing. These may contribute, over a 1-year time horizon, to substantial excess mortality among people with cancer and multimorbidity. It is urgent to understand how the recovery of general practitioner, oncology and other hospital services might best mitigate these long-term excess mortality risks.