Global changes to the chemotherapy service during the covid-19 pandemic

Abstract

Purpose In response to the COVID-19 pandemic, changes to chemotherapy services were implemented as a means of managing imposed workload strains within health services and protecting patients from contracting COVID-19. Given the rapidly evolving nature of the pandemic many changes were rapidly adopted and were not substantiated by robust evidence. This study aimed to describe the changes adopted internationally to chemotherapy services, which may be used to guide future changes to treatment delivery. Methods A survey was developed to understand the impact of COVID-19 on the delivery of systemic anti-cancer therapies (SACT). It comprised 22 questions and examined the strategies implemented during the pandemic to prioritise and protect patients receiving SACT and the participants’ professional opinion of the strategies employed. The survey was available in English, Spanish and French and was distributed via professional bodies. Results 129 responses were obtained from healthcare professionals working across 17 different countries. 45% of institutions had to implement treatment prioritisation strategies and all hospitals implemented changes in the delivery of treatment, including: reduction in treatments (69%), using less immunosuppressive agents (50%), allowing treatment breaks (14%) and switching to oral therapies (45%). Virtual clinic visits were perceived by participants as the most effective strategy to protect patients. Conclusions The pandemic has forced chemotherapy healthcare professionals to adopt new ways of working by reducing health interactions. Many areas of research are needed following this period, including understanding patients’ perceptions of risks to treatment, utilisation of oral treatments and the impact of treatment breaks on cancer outcomes.

The Impact of COVID-19 on the Delivery of Systemic Anti-Cancer Treatment at Guy’s Cancer Centre

“…Furthermore, there was a lower proportion of patients receiving chemotherapy in 2020 when compared to 2019. This is indicative of the modification of SACT usage due to the COVID-19 pandemic as suggested in the survey by Chow et al [ 6 ]. Clinicians had to weigh up the risks of patients coming into hospital to receive chemotherapy and hence it was deemed more appropriate and safer for some patients to receive alternative treatment options with a less myelosuppressive profile.…”

“…The COVID-19 pandemic has forced hospitals around the world to make difficult decisions regarding the continuation of care for cancer patients. In a recent survey completed by health care professionals working across 17 countries, all institutions implemented some sort of change into the delivery of anti-cancer treatment whether this be treatment delays, prioritisations or using less immunosuppressive drugs [ 6 ]. In our study, it was noted that there was an increase in the proportion of patients with stage IV disease being treated in 2020 when compared to 2019.…”

Healthcare Professional and Patient Perceptions of Changes in Colorectal Cancer Care Delivery During the COVID-19 Pandemic and Impact on Health Inequalities

“…In a study exploring global changes to chemotherapy service during the pandemic, nearly half of institutions surveyed reported implementing treatment prioritisation strategies where treatment was postponed, reduced or stopped for some patients. 46 Evidence already shows that lower SES groups are less likely to receive treatment for colorectal cancer 47 and therefore this is another potential area where inequalities may be perpetuated.…”

Impact of Telemedicine Modality on Quality Metrics in Diverse Settings: Implementation Science–Informed Retrospective Cohort Study

“…Informed by prior rapid-cycle qualitative analysis approaches, we focused on specific research questions on implementation (ie, telemedicine barriers and facilitators) [ 20 ] and used the framework method to analyze free-text comments in Microsoft Excel [ 18 , 21 , 22 ]. Following an unstructured familiarization phase, initial codes were developed, and in a subsequent coding phase, final themes were identified, with relevant qualitative data tabulated by theme.…”