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French public warned: ‘Do not delay GP visit due to Covid’

Delayed doctor appointments during the first lockdown may cause as many as 1,000-6,000 extra deaths from cancer in future years, a new study has found

France residents are warned not to avoid seeing the doctor - even during the Covid epidemic - as researchers estimate that up to 6,000 extra cancer deaths may be caused by the first lockdown.

The public is warned not to cancel, miss, or delay appointments with a doctor or healthcare professional for any lingering concerns, questions or persistent symptoms - as delayed diagnoses of serious medical conditions, especially possible cancer, could have severe consequences.

A new study from hospital network Unicancer - a group of 18 oncology centres - found that delays and missed appointments linked to the first lockdown could cause of up to 1,000-6,000 extra deaths from cancer in the next few years, due to cases not having been detected and diagnosed earlier.

The study shows that from March to July 2020, the number of cancer patients in France fell by 23.3% compared to the year before, when normally that figure would be expected to rise year-on-year.

Among the Unicancer clinics, the fall was lower - at 6.8% on average - but there was still a marked drop in April and May (21%).

In order to estimate the possible impact this will have on mortality levels, the researchers used a previous UK study published in the British Medical Journal. This estimated that the mortality risk of cancer patients increases by 1.06 for each month of delay.

This means that the reduction in diagnoses in France could lead to between 1,000 to 6,000 extra deaths in the years to come, the study said.

Professor Jean-Yves Blay, oncologist at the Léon Bérard de Lyon unit, who led the study, told newspaper Le Figaro: “These are people who will die from their cancer instead of from something else.”

The figures must be taken with caution, however, as they have not yet been peer reviewed or officially published, and the study is also based on the principle that the figures “caught up” in August - which the scientific consensus has said is likely not the case in reality.

Causes for delay

The reduction in diagnoses and treatment linked to the Covid-19 pandemic is due to multiple factors, Professor Blay said.

He said: “On the one hand, some centres closed their test clinics or had reduced availability during this period. On the other hand, some people were afraid to go to hospital during this epidemic period and preferred to postpone their appointment.

“Added to this are the people who had symptoms, who would have gone to their GP during normal times, but who did not go because of fear of contracting Covid at the doctor’s surgery.”

Yet, the mortality and impact of some delayed diagnoses differ depending on the case.

Dr Olivier Trédan, also an oncologist at the Léon Bérard de Lyon unit, but who was not involved in the study, said: “An older woman with less-aggressive, smaller breast cancer who has seen a three-month delay in getting treatment will not significantly have impacted her chances of recovery.

“In contrast, in the case of - say - an aggressive, potentially-curable pancreas cancer, this same amount of time could cause it to become inoperable.”


Already-diagnosed cases less affected

Professor Blay was more optimistic about the consequences of the epidemic on those whose cancer had already been diagnosed.

Figures from the Institut National de Cancer show that operations intended to remove cancer tumours dropped by 17% in France from March to August 2020, compared to 2019.

A total of 20,142 surgeries were delayed, with the most being for oesophageal cancer (22%) and the least for ovarian (6%).

Professor Blay said: “Within Unicancer, according to our calculations, the impact of these postponements is minor-to-nothing. There were very few times when the lack of access to intensive care units for complex or risky cases was not able to be made up by an alternative solution.”

Similarly, he said that even delays to operations could be compensated by additional chemotherapy or radiotherapy to slow down the growth of a tumour.

Yet, the study only considered the impact on mortality levels, and not whether the patients’ quality of life was affected or worsened by the delays. Waiting longer for an operation may make treatment more intense further down the line.

Dr Trédan said: “A patient who we could otherwise have diagnosed in April may not have been prescribed postoperative chemotherapy [at that time], but if the operation now takes place in September [instead], it may now need to be prescribed.”

Overall, the message to the public is: Do not delay seeking treatment or GP appointments in case of any worries, symptoms, doubts, or questions - even during the current pandemic.

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