Senior Research Fellow School of Population Health, UNSW Sydney Kensington, Australia
Background COVID-19 has caused significant disruptions to cancer care, globally. Australia entered a nationwide lockdown from March–June 2020 and its two most populous states again from July–October 2021; the outbreak of the omicron variant in December 2021 caused widespread reductions in mobility. The impact of these events on systemic cancer treatment in Australia is unknown.
Objectives Quantify changes in systemic cancer therapy during the COVID-19 pandemic in Australia.
Methods Data: de-identified records of government-subsidised cancer medicines dispensed to a random 10% sample of Australians between January 2017 to July 2022. Analyses: Interrupted time series analysis to examine changes during times of increased COVID-19 risk and related public health measures (March and April 2020, July 2021, and January 2022). Outcomes: monthly dispensing and initiation rates of antineoplastic (chemo-, immuno- and targeted therapy), endocrine and supportive medicines/100,000 population; monthly discontinuation rates (defined as ≥90 days gap between cancer medicine dispensings)/1,000 people treated; and incident rate ratios (IRR) for all outcomes during 2021-22.
Results Overall, we did not observe reductions in antineoplastic dispensing or initiation during March 2020. During April 2020, we observed an increase of 39/100,000 (95%CI: 14, 65/100,000) in antineoplastic dispensing, driven by immunotherapy and targeted therapy; and a decrease in chemotherapy initiation (-2/100,000, 95 CI: -4, -1/100,000) and increase in discontinuation of all antineoplastic medicines (35/1,000, 95%CI: 20, 51/1,000). These changes were not sustained beyond April 2020. There were no changes in antineoplastics dispensings, initiations, or discontinuations during the 2021 lockdowns. During the omicron outbreak there were significant decreases in antineoplastics dispensings in both NSW (IRR: 0.89 [95%CI: 0.84, 0.93]) and VIC (IRR: 0.92 [95%CI: 0.88, 0.96]); decreases in endocrine therapy initiations (NSW IRR: 0.85 [95%CI: 0.74, 0.99]; VIC IRR: 0.78 [95%CI: 0.65, 0.94]); and no changes in discontinuations.
Conclusions Despite multiple, prolonged lockdowns and the rapid escalation in case numbers during the omicron outbreak, we observed only small and transient changes in the use of some cancer medicines early in the pandemic. The effective control of COVID-19 in Australia appears to have mitigated the impacts of COVID-19 on systemic cancer therapy in the short term, but later effects of reduced cancer screening and delayed diagnoses remain to be seen.
