Lockdown skin cancer diagnosis delays linked to deaths and £6bn costs in Europe

Delays in diagnosing melanoma due to Covid-19 lockdown may have contributed to over 100,000 years of life lost across Europe and over £6bn in costs, mainly indirectly due to loss of productivity, finds a new study led by UCL and University Hospital of Basel researchers.

The authors of the new JAMA Network Open paper say their findings show how vital early detection of cancer can be, while also highlighting the importance of considering unintended side effects in any future pandemic planning.

Co-lead author Dr Kaustubh Adhikari (UCL Genetics, Evolution & Environment and The Open University) said: “When lockdowns were introduced as a much-needed measure to stop the spread of Covid-19, there were extensive unintended consequences. Many screenings were cancelled and medical treatments were delayed.

“As many people missed appointments to detect or treat skin cancer, their cancer progressed to a later stage, which resulted in more expensive care and a greater risk that the treatment would not be successful.

“It’s alarming that for just one disease, there were many years of life lost, a lower quality of life for many thousands of people, and billions of pounds of economic impact – this may be just the tip of the iceberg of the consequences of delayed diagnosis and treatment due to lockdowns. While the lockdowns did save many lives by mitigating the toll of Covid-19 itself, it is important that we learn from the experience to ensure that if another pandemic arises, we can effectively balance different healthcare priorities.”

The team of researchers, from the UK, Switzerland, Germany, US, Italy, Australia and Hungary, were investigating the health economic consequences of delays in diagnosing melanoma, a common type of skin cancer and one of the 10 most common cancers in Europe. The analysis was based on information from 50,072 patients of two cancer treatment centres in Switzerland and Italy, supported by further data from the UK and Belgium.

The researchers estimated how many people’s cancer would have progressed from one stage to the next due to delays in beginning or continuing treatment, as both screening services and treatments were disrupted in 2020 and 2021 due to lockdown restrictions, staff shortages, and fear of infection. They estimated that for roughly 17% of people with melanoma, their cancer would have progressed to a higher stage in 2020-2021, due to delays in diagnosis or treatment of two to three months or longer.

The research team then estimated the additional medical costs, as treating later-stage cancer is more expensive and comes with a lower chance of success. These cost estimates included both the direct costs to healthcare providers (such as the NHS), as well as the broader impacts such as the loss of productivity (indirect costs) due to disability and years of life lost.

The researchers estimated that delays to melanoma diagnoses contributed to 111,464 years of life lost across 31 countries in Europe, with a total economic cost of £6.1bn (€7.1bn or $7.7bn USD). Most of the costs (94.5%) were indirect costs such as loss of productivity.

Co-lead author Dr Elisabeth Roider (University Hospital of Basel) said: “Our findings show that preventative healthcare always needs to be a top priority, both in normal times and in times of crisis; any plans for potential future pandemics need to consider unintended side effects on a wide range of health conditions and plan holistically.

“Delays to diagnosis and treatment can be devastating to people affected by cancer, so getting prompt evaluation and treatment is vital for people concerned about their health, while screening programmes need to be treated as a priority by healthcare system leaders.”

The research was supported by the Research Foundation of the University of Basel, the ProPatient Foundation, University Basel, the Goldschmidt Jacobson Foundation, and the Swiss National Science Foundation.