Feasibility and usability of a regional hub model for colorectal cancer services during the COVID-19 pandemic

Abstract

The outbreak of the COVID-19 pandemic produced unprecedented challenges, at a global level, in the provision of cancer care. With the ongoing need in the delivery of life-saving cancer treatment, the surgical management of patients with colorectal cancer required prompt significant transformation. The aim of this retrospective study is to report the outcome of a bespoke regional Cancer Hub model in the delivery of elective and essential colorectal cancer surgery, at the height of the first wave of the COVID-19 pandemic. 168 patients underwent colorectal cancer surgery from April 1st to June 30th of 2020. Approximately 75% of patients operated upon underwent colonic resection, of which 47% were left-sided, 34% right-sided and 12% beyond total mesorectal excision surgeries. Around 79% of all resectional surgeries were performed via laparotomy, and the remainder 21%, robotically or laparoscopically. Thirty-day complication rate, for Clavien–Dindo IIIA and above, was 4.2%, and 30-day mortality rate was 0.6%. Re-admission rate, within 30 days post-discharge, was 1.8%, however, no patient developed COVID-19 specific complications post-operatively and up to 28 days post-discharge. The established Cancer Hub offered elective surgical care for patients with colorectal cancer in a centralised, timely and efficient manner, with acceptable post-operative outcomes and no increased risk of contracting COVID-19 during their inpatient stay. We offer a practical model of care that can be used when elective surgery “hubs” for streamlined delivery of elective care needs to be established in an expeditious fashion, either due to the COVID-19 pandemic or any other future pandemics.

Global elective breast- and colorectal cancer surgery performance backlogs, attributable mortality and implemented health system responses during the COVID-19 pandemic: A scoping review

“…Twenty-three articles reported structural health system responses; 17 originated from HICs (Italy, France, U.K. and USA) and 6 from LMICs (Brazil, India, China, Turkey) [ 5 – 7 , 18 , 21 – 24 , 26 , 38 , 41 , 43 , 53 – 55 , 61 – 67 , 74 ]. The studies each outlined institutional health system responses, with exceptions of a global cross-sectional survey, a cohort study, a systematic review and a scoping review, which respectively synthesised data from international sources [ 55 , 58 – 60 ].…”

“…Thirteen studies (originating from Italy, U.K., France, Brazil, India and China, respectively) described the establishment of designated COVID-19 screening-, diagnostic or treatment pathways, separate to other hospital departments for patients without COVID-19 [ 6 , 7 , 18 , 22 , 24 , 41 , 53 , 59 , 62 – 64 , 66 , 67 ]. To aid patients’ navigation of adapted hospital pathways, a hospital map was designed at an Italian centre [ 6 ].…”

“…Within a U.K.-based COVID-19-protected surgical treatment pathway, of 168 patients who underwent colorectal cancer surgery (between April–June 2020), the 30-day mortality rate was 0.6% [ 41 ]. No COVID-19-related complications arose postoperatively or for 28 days post-discharge [ 41 ]. The readmission rate within 30 days post-discharge was 1.8% [ 41 ].…”

“…No COVID-19-related complications arose postoperatively or for 28 days post-discharge [ 41 ]. The readmission rate within 30 days post-discharge was 1.8% [ 41 ].…”