Impact of SARS-CoV-2 pandemic on pancreatic cancer services and treatment pathways: United Kingdom experience

Abstract

Introduction The SARS-CoV-2 pandemic presented healthcare providers with an extreme challenge to provide cancer services. The impact upon the diagnostic and treatment capacity to treat pancreatic cancer is unclear. This study aimed to identify national variation in treatment pathways during the pandemic. Methods A survey was distributed to all United Kingdom pancreatic specialist centres, to assess diagnostic, therapeutic and interventional services availability, and alterations in treatment pathways. A repeating methodology enabled assessment over time as the pandemic evolved. Results Responses were received from all 29 centres. Over the first six weeks of the pandemic, less than a quarter of centres had normal availability of diagnostic pathways and a fifth of centres had no capacity whatsoever to undertake surgery. As the pandemic progressed services have gradually improved though most centres remain constrained to some degree. One third of centres changed their standard resectable pathway from surgery-first to neoadjuvant chemotherapy. Elderly patients, and those with COPD were less likely to be offered treatment during the pandemic. Conclusion The COVID-19 pandemic has affected the capacity of the NHS to provide diagnostic and staging investigations for pancreatic cancer. The impact of revised treatment pathways has yet to be realised.

Outcomes of patients undergoing elective liver and pancreas cancer surgery during the SARS-CoV-2 pandemic: an international, multicentre, prospective cohort study

“…It is possible that there was greater patient selection post-peak with lower risk patients undergoing surgery not reflected in the observed variables, explaining the lower mortality rate. This observation was identified by a UK study, showing one third of pancreatic centres changes their management strategy for patients with borderline-resectable venous disease from a surgery-first approach to neo-adjuvant therapy at the beginning of the pandemic (7).…”

“…Worldwide, liver and pancreas cancer surgery has been impacted by availability of postoperative ICU support, with only 5%-14% units reporting normal operative during pandemic the peak of the pandemic (7,36). Providing safe pathways to protect patients from perioperative SARS-CoV-2 infection and providing ICU care where needed is a clear priority.…”

“…This study acknowledges several limitations. Firstly, only patients who had an operation were included, and previous work has identified that large numbers of elective operations were cancelled (7,46,47). Our data may focus on those representing either low SARS-CoV-2 infection incidence areas, or those prioritized for surgery owing to their underlying disease (1).…”

“…Fear of peri-operative mortality among patients undergoing major liver and pancreas cancer surgery in the setting of SARS-CoV-2 has also affected allocation of surgery. Early studies reporting 30-day mortality from perioperative SARS-CoV-2 as high as 23.8% have been a key driver for this (4)(5)(6)(7). Patients undergoing surgery for pancreatic and liver cancers are already at higher risk of poor peri-operative outcomes compared to other cancers (8).…”

Impact of Covid-19 on Gastrointestinal Cancer Surgery: A National Survey

“…English centres reported a decrease of 40% in oncological pancreatic resections during active Covid phase. [38,39] Similarly a large multicentre study on impact of Covid-19 on liver cancer management reported 50% decrease in curative resections. [40] The disruption was minimal in colorectal surgeries across the participating centres with some centres reporting an increase of up to 22% in colorectal cancer resections including minimally invasive resections.…”