Canadian Cancer Centre Response to COVID-19 Pandemic: A National and Provincial Response

Abstract

Background: COVID-19 has spread rapidly, requiring health delivery systems to undertake dramatic transformations. To evaluate these system changes, we undertook one of the first Canadian health delivery system reviews and the first Canadian cancer centre evaluation of pandemic system modifications. Methods: Questionnaires were distributed to the Canadian Association of Provincial Cancer Agencies (CAPCA) members in order to assess changes to cancer centre services and patient management. Documentation relating to COVID-19 from the CAPCA electronic space was accessed, and all publicly available cancer centre documentation related to COVID-19 was reviewed. Results: Seven provinces completed the questionnaire and had documentation available from the CAPCA electronic space. All screening programs across Canada were suspended. In most provinces surveyed, ≥50% of outpatient appointments were occurring virtually, with <25% using video platforms. Generally, the impact on diagnostic imaging and new patient referrals correlated with the impact of COVID-19. Most provinces had a reduction in operating room availability, with chemotherapy and radiation treatments continuing. Public health modification, including personal protective equipment and screening staff, varied across the country. Conclusion: Canadian cancer centres underwent a rapid and aggressive transformation of services in response to COVID-19, with many similarities and differences across provinces. In part, this response was facilitated by communication under a national association, which in Canada remains unique to cancer. This response may serve to inform changes in other jurisdictions or disease states now and in future waves of the pandemic, as well as a record of changes for future health services and patient outcome research.

Evaluating the Impact of the COVID-19 Pandemic on New Cancer Diagnoses and Oncology Care in Manitoba

“…Elective surgeries were postponed. Radial cancer surgeries were prioritized within disease sites or delayed at the discretion of treating physicians due to a reduction in operation room availability [6].…”

“…However, the decrease in the number of surgical resections exceeded the decrease in cancer diagnoses by 20% in 2020. It is also important to note that the need to triage cancer surgery was anticipated and planned for at the start of the pandemic in Manitoba [6]. Therefore, some individuals may have experienced different treatment pathways than before COVID-19 which may impact survival.…”

“…While the number of all visits to CCMB did not change, the number of in-person visits decreased by one-half and were replaced by telephone/video visits. Telephone or video visits were not commonly used prior to the pandemic due to the absence of provincial physician billing codes and privacy concerns, but quickly became integral to the provision of cancer care [6]. These visits have advantages including increased patient convenience and accessibility and lower transportation costs but also potential limitations such as technical issues, inability to complete a full physical examination, and privacy considerations [24].…”

“…Treatments are often complex, requiring multidisciplinary teams to co-ordinate care and communicate clearly and effectively with patients and their families. Physical distancing, the reallocation of health care resources, and the need to implement new procedures to reduce the spread of COVID-19 may also have serious consequences for people with cancer including delays in cancer screening, diagnosis, and treatment [5][6][7][8][9][10]. In addition to health system changes, patients may also be afraid to access the health care system or experience new barriers to care [11,12].…”

Supporting breast cancer survivors via text messages: reach, acceptability, and utility of EMPOWER-SMS

“…Structured post-treatment support is sparse [4] and available services are inaccessible to many patients due to in-person delivery, limiting attendance for those in rural and remote areas, and/or those with work or family responsibilities, financial stressors, or mobility issues [5]. Moreover, the recent global novel coronavirus disease (COVID-19) pandemic has caused widespread and unpredictable cancellations of in-person cancer-related appointments [6,7]. There is an urgent need for accessible, inexpensive, and easily scalable support strategies.…”