Delivery of Cancer Care in Ontario, Canada, During the First Year of the COVID-19 Pandemic

Walker, Mark; Wang, Jonathan; Mazuryk, Joshua; Skinner, Siew-Mei; Meggetto, Olivia; Ashu, Eta Ebasi; Habbous, Steven; Rad, Narges Nazeri; Espino-Hernández, Gabriela; Wood, Ryan; Chaudhry, Munaza; Vahid, Saba; Gao, Julia; Gallo-Hershberg, Daniela; Gutierrez, Eric; Zanchetta, Claudia; Langer, Deanna L.; Zwicker, Victoria; Rey, Michelle; Tammemägi, Martin C.; Tinmouth, Jill; Kupets, Rachel; Chiarelli, Anna M.; Singh, Simron; Warde, Padraig; Forbes, Leta; Dobranowski, Julian; Irish, Jonathan C.; Rabeneck, Linda; Adhihetty, Chamila; Beca, Jaclyn; Burns, Diane; Chan, Catherine; Chan, Kelvin K.; Chun, Lauren; Coulson, Melissa; Darling, Gail; De, Prithwish; Dong, Steven; Dubé, Catherine; Eberg, Maria; Fienberg, Samantha; Fox, Colleen; Foxcroft, Sophie; Fung, Ron; Gavura, Scott; Gray, Natasha; Hertz, Sherrie; Ho, Brian; Holloway, Claire; Hunter, Amber; Jembere, Nathaniel; Karapetyan, Tina; Kaushal, Shivali; King, Mary Jane; Linton, Ordeena; Lofters, Aisha; Mackesy, Andrea; Majeed, Faisal; Mann, Jessica M.; MacCrostie, Pamela; Matheson, Garth; McCurdy, Bronwen R.; Meertens, Elaine; Menalo, Reeza; Milgram, Lisa; Moleschi, Nicole; Mow, Elena; Murphy, Kate; Naipaul, Rohini; Nguyen, Karen; O'Grady, Diane; Pollett, Aaron; Quilliam, Elizabeth; Radebe, Dimpho; Sacco, Joe; Shukla, Nancy; Simanovski, Vicky; Scott, Steve; Tai, Xiaochen; Tassone, Cristina; Theivendram, Arany; Truscott, Rebecca; Wang, Christa; Wong, Audrey; Yeung, Latifa; Yurcan, Marta

doi:10.1001/jamanetworkopen.2022.8855

Cited by 55 publications

(48 citation statements)

References 27 publications

(74 reference statements)

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“…To this effect, many nonurgent surgical procedures to treat cancer were postponed. [4][5][6] Consequently, some patients with cancer who were eligible for primary surgical resection could be offered neoadjuvant systemic treatment (ST), with the intent that surgery would occur at a later date when hospital burden had subsided.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Use of Neoadjuvant Systemic Treatment for Breast Cancer and Short-term Outcomes Before vs During the COVID-19 Era in Ontario, Canada

et al. 2022

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IMPORTANCEIn response to an increase in COVID-19 infection rates in Ontario, several systemic treatment (ST) regimens delivered in the adjuvant setting for breast cancer were temporarily permitted for neoadjuvant-intent to defer nonurgent breast cancer surgical procedures. OBJECTIVE To examine the use and compare short-term outcomes of neoadjuvant-intent vs adjuvant ST in the COVID-19 era compared with the pre-COVID-19 era. DESIGN, SETTING, AND PARTICIPANTS This was a retrospective population-based cohort study inOntario, Canada. Patients with cancer starting selected ST regimens in the COVID-19 era (March 11, 2020, to September 30, 2020 were compared to those in the pre-COVID-19 era (March 11, 2019, to March 10, 2020. Patients were diagnosed with breast cancer within 6 months of starting systemic therapy. MAIN OUTCOMES AND MEASURESEstimates were calculated for the use of neoadjuvant vs adjuvant ST, the likelihood of receiving a surgical procedure, the rate of emergency department visits, hospital admissions, COVID-19 infections, and all-cause mortality between treatment groups over time. RESULTS Among a total of 10 920 patients included, 7990 (73.2%) started treatment in the pre-COVID-19 era and 7344 (67.3%) received adjuvant ST; the mean (SD) age was 61.6 (13.1) years.Neoadjuvant-intent ST was more common in the COVID-19 era (1404 of 2930 patients [47.9%]) than the pre-COVID-19 era (2172 of 7990 patients [27.2%]), with an odds ratio of 2.46 (95% CI, 2.26-2.69; P < .001). This trend was consistent across a range of ST regimens, but differed according to patient age and geography. The likelihood of receiving surgery following neoadjuvant-intent chemotherapy was similar in the COVID-19 era compared with the pre-COVID-19 era (log-rank P = .06). However, patients with breast cancer receiving neoadjuvant-intent hormonal therapy were significantly more likely to receive surgery in the COVID-19 era (log-rank P < .001). After adjustment, there were no significant changes in the rate of emergency department visits over time between patients receiving neoadjuvant ST, adjuvant ST, or ST only during the ST treatment period or postoperative period.Hospital admissions decreased in the COVID-19 era for patients who received neoadjuvant ST compared with adjuvant ST or ST alone (P for interaction = .01 for both) in either setting. CONCLUSIONS AND RELEVANCEIn this cohort study, patients were more likely to start neoadjuvant ST in the COVID-19 era, which varied across the province and by indication. There was limited evidence to suggest any substantial impact on short-term outcomes.

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Section: Introductionmentioning

confidence: 99%

Comparison of Use of Neoadjuvant Systemic Treatment for Breast Cancer and Short-term Outcomes Before vs During the COVID-19 Era in Ontario, Canada

et al. 2022

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“…The increased rate of surgery during the pandemic period after chemotherapy might reflect patients who would have otherwise had surgery upfront but were placed on neoadjuvant chemotherapy instead due to directed prioritization of non-surgical cancer treatments at the beginning of the pandemic [ 4 , 5 ]. This speculation is supported by a range of population-level analyses showing a sharp decrease in cancer surgery volume in the early pandemic [ 1 , 23 , 29 , 30 ]. Our results may also reflect the temporal shifts towards neoadjuvant approaches that are not specifically driven by the pandemic [ 31 , 32 ].…”

Section: Discussionmentioning

confidence: 93%

“…Surgery is central to the management of many cancers as it represents the only curative modality. The ongoing COVID-19 pandemic has caused disruption in cancer services with evidence of delayed diagnoses and poor access to surgery [ 1 ]. As surgeries were delayed, the use of neoadjuvant chemotherapy was expanded.…”

Section: Introductionmentioning

confidence: 99%

Cancer Patients First Treated with Chemotherapy: Are They More Likely to Receive Surgery in the Pandemic?

Sutradhar

Dare

et al. 2022

Current Oncology

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Due to the ramping down of cancer surgery in early pandemic, many newly diagnosed patients received other treatments first. We aimed to quantify the pandemic-related shift in rate of surgery following chemotherapy. This is a retrospective population-based cohort study involving adults diagnosed with cancer between 3 January 2016 and 7 November 2020 in Ontario, Canada who received chemotherapy as first treatment within 6-months of diagnosis. Competing-risks regression models with interaction effects were used to quantify the association between COVID-19 period (receiving a cancer diagnosis before or on/after 15 March 2020) and receipt of surgical reSection 9-months after first chemotherapy. Among 51,653 patients, 8.5% (n = 19,558) of them ultimately underwent surgery 9-months after chemotherapy initiation. Receipt of surgery was higher during the pandemic than before (sHR 1.07, 95% CI 1.02–1.13). Material deprivation was independently associated with lower receipt of surgery (least vs. most deprived quintile: sHR 1.11, 95% CI 1.04–1.17), but did not change with the pandemic. The surgical rate increase was most pronounced for breast cancer (sHR 1.13, 95% CI 1.06–1.20). These pandemic-related shifts in cancer treatment requires further evaluations to understand the long-term consequences. Persistent material deprivation-related inequity in cancer surgical access needs to be addressed.

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“…Although multiple worldwide COVID-19 waves have passed at the time of this writing, it is evident that healthcare systems across the globe still face the threat of emerging variants and new potential pandemics in the future. This study only investigated two centers in the same city, thereby limiting the external validity as it relates to other cities and provinces within Canada which may have implemented different triage policies during this time [ 27 ]. Further exploration of HNC patient care in other Canadian centers during the pandemic, along with a prospective evaluation of this transparent model for patient-centered OR prioritization in those different settings, would help determine its role on the national level moving forward.…”

Section: Discussionmentioning

confidence: 99%

Prioritization of head and neck cancer patient care during the COVID-19 pandemic: A retrospective cohort study

Psycharis

Salameh

Turkdogan

et al. 2023

Journal of Otolaryngology - Head & Neck Surgery

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Background The COVID-19 pandemic placed considerable strain on the healthcare system, leading to the re-allocation of resources and implementation of new practice guidelines. The objective of this study is to assess the impact of COVID-19 guideline modifications on head and neck cancer (HNC) care at two tertiary care centers in Canada. Methods A retrospective cohort study was conducted. HNC patients seen at two tertiary care centers before and after the onset of the COVID-19 pandemic (pre-pandemic: July 1st, 2019, to February 29th, 2020; pandemic: March 1st, 2020, to October 31st, 2020) were included. The pre-pandemic and pandemic cohorts were compared according to patient and tumor characteristics, duration of HNC workup, and treatment type and duration. Mean differences in cancer care wait times, including time to diagnosis, tumor board, and treatment as well as total treatment package time and postoperative hospital stay were compared between cohorts. Univariate and multivariate analyses were used to compare characteristics and outcomes between cohorts. Results Pre-pandemic (n = 132) and pandemic (n = 133) patients did not differ significantly in sex, age, habits, or tumor characteristics. The percentage of patients who received surgery only, chemo/radiotherapy (CXRT) only, and surgery plus adjuvant CXRT did not differ significantly between cohorts. Pandemic patients experienced a significant time reduction compared to pre-pandemic patients with regards to the date first seen by a HNC service until start of treatment ($$\overline{x}$$ x ¯ = 48.7 and 76.6 days respectively; p = .0001), the date first seen by a HNC service until first presentation at tumor board ($$\overline{x}$$ x ¯ = 25.1 and 38 days respectively; p = .001), mean total package time for patients who received surgery only ($$\overline{x}$$ x ¯ = 3.7 and 9.0 days respectively; p = .017), and mean total package time for patients who received surgery plus adjuvant CXRT ($$\overline{x}$$ x ¯ = 80.2 and 112.7 days respectively; p = .035). Conclusion The time to treatment was significantly reduced during the COVID-19 pandemic as compared to pre-pandemic. This transparent model of patient-centered operative-room prioritization can serve as a model for improving resource allocation and efficiency of HNC care during emergency and non-emergency scenarios.

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Delivery of Cancer Care in Ontario, Canada, During the First Year of the COVID-19 Pandemic

Cited by 55 publications

References 27 publications

Comparison of Use of Neoadjuvant Systemic Treatment for Breast Cancer and Short-term Outcomes Before vs During the COVID-19 Era in Ontario, Canada

Comparison of Use of Neoadjuvant Systemic Treatment for Breast Cancer and Short-term Outcomes Before vs During the COVID-19 Era in Ontario, Canada

Cancer Patients First Treated with Chemotherapy: Are They More Likely to Receive Surgery in the Pandemic?

Prioritization of head and neck cancer patient care during the COVID-19 pandemic: A retrospective cohort study

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