The impact of COVID-19 pandemic on health care service provision for patients with newly diagnosed cancer

Date of Approval
Application Number
Technical Summary

This study aims to evaluate the impact of the pandemic on change in health care service provision for patients with cancer. We aim to retrospectively evaluate previous attendances using the interrupted time series study design. A time series is a continuous sequence of observations within a population over a specific time interval. Focusing on patients with newly diagnosed cancer (incident cancers), we will analyze trends in GP and hospital attendances for cancer patients (counts by month and percentage change year-on-year by month). We will perform interrupted time series analysis of primary care and hospital attendances (weekly counts) by cancer type, number and types of comorbidities, index of multiple deprivation and sex. We will estimate the impact of missed attendances on excess mortality using an instrumented difference-in-differences design, using the COVID-19 pandemic as the instrument. To define the level of the instrumental variable, we will select time periods when a marked decrease in attendances is observed. The relationship between weekly attendances and mortality will be estimated using the least-squares method. This study can help establish the scale of the indirect effects of the pandemic to ascertain the long-term effects of reduced contact with health and care systems. By estimating the unintended harm that may have resulted from the pandemic's response on health care seeking behavior and the provision of health care for non-COVID19 conditions, these findings could help alert policymakers on the importance of ensuring that measures put in place to control COVID-19 will not adversely impact the management of cancer.

Health Outcomes to be Measured

GP attendances, hospital in-patient admissions; hospital outpatient admissions; mortality all-cause; mortality cause-specific


Alvina Lai - Chief Investigator - University College London ( UCL )
Alvina Lai - Corresponding Applicant - University College London ( UCL )
Arturo Gonzalez-Izquierdo - Collaborator - University College London ( UCL )
Muhammad Qummer ul Arfeen - Collaborator - University College London ( UCL )
Wai Chang - Collaborator - University College London ( UCL )
Yen Yi Tan - Collaborator - University College London ( UCL )
Yulei Fan - Collaborator - University College London ( UCL )


HES Accident and Emergency;HES Admitted Patient Care;HES Outpatient;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation