Collateral damage: the impact on outcomes from cancer surgery of the COVID-19 pandemic

Abstract

A COVID19 lockdown in India posed signi cant challenges to the continuation of radiotherapy (RT) and systemic therapy services. While several COVID19 service guidelines have been promulgated, implementation data is yet unavailable. We performed a comprehensive audit of the implementation of services in a clinical oncology department. METHODS AND MATERIALS: A departmental protocol of priority-based treatment guidance was developed and a departmental staff rotation policy was implemented. Data was collected for the period of lockdown on outpatient visits, starting, and delivery of RT and systemic therapy. Adherence to protocol was audited, and factors affecting change from pre-COVID standards analyzed by multivariate logistic regression. RESULTS: Outpatient consults dropped by 58%. Planned RT starts were implemented in 90%, 100%, 92%, 90% and 75% of priority level 1-5 patients. While 17% had a deferred start, the median time to start of adjuvant RT and overall treatment times were maintained. Concurrent chemotherapy was administered in 89% of those eligible. Systemic therapy was administered to 84.5% of planned patients with 33% and 57% of curative and palliative patients receiving modi ed or deferred cycles. The patient's inability to come was the commonest reason for RT or ST deviation. Factors independently associated with a change from pre-COVID practice was priority level allocation for RT and age and palliative intent for systemic therapy. CONCLUSIONS: Despite signi cant access limitations a planned priority-based system of delivery of treatment could be implemented.

Collateral effects of the coronavirus disease 2019 pandemic on lung cancer diagnosis in Korea

“…A modeling study that analyzed the impact of delayed cancer surgery as a result of the COVID-19 pandemic reported that a three-month and six-month delay of surgery decreased the anticipated life-years gain after surgery by 19% and 43%, respectively. 23 Moreover, the impact was greater among patients with lung cancer. A dilemma occurs when elective surgeries are postponed in adherence to physical distancing and reorganization of healthcare resources because it contradicts the goal of minimizing delay of curative surgeries.…”

Collateral effects of the coronavirus disease 2019 pandemic on lung cancer diagnosis in Korea

“…Anticancer therapy or surgery was postponed or canceled. A modeling study that analyzed the impact of delayed cancer surgery due to the COVID-19 pandemic reported that a three-month and six-month delay of surgery decreased the anticipated life-years gain after surgery by 19 and 43%, respectively [ 23 ]. Moreover, the impact was greater among patients with lung cancer.…”

Trends of Interventional Radiology procedures during the Covid-19 pandemic: The first 27 weeks in the eye of the storm

“…While deliberate postponement of "non-essential" procedures would be intuitive in the onset of any major outbreak, this approach is not sustainable in a protracted pandemic. The negative impact of pandemic-related treatment delays on COVID-free patients are increasingly being recognized [10][11][12], and poses many challenges for the post-pandemic recovery.…”

“…Throughout the pandemic, IR services needed to balance between infection risk and resource optimization, against the delay of care for COVID-free patients [10][11][12]. Guidelines for procedural prioritization and acceptable delays such as the Procedure Acuity Scale (IR-PAS), by The Society of Intervention Radiology [13], which was adapted from the American College of Surgeons Elective Surgery Acuity Scale, were developed [14].…”