The impact of COVID-19 on systemic anticancer treatment delivery in Scotland

Baxter, Mark; Murphy, John; Cameron, David; Jordan, Judith; Crearie, Christine; Lilley, Christina; Sadozye, Azmat; MacLean, Morag; Hall, Peter; Phillips, Angela; Greger, Alex; Madeleine, Jude; Petty, Russell

doi:10.1038/s41416-021-01262-8

Cited by 28 publications

(32 citation statements)

References 10 publications

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“… [26] In the same region, weekly attendances for systemic cancer therapy fell by approximately 30% in England, Northern Ireland and Scotland. [ 27 , 28 ] Single-centre studies from the US report that around half of patients on chemotherapy had treatment modifications in February to April 2020. [ 29 , 30 ] A systematic review found evidence of significant delays and disruptions to cancer care worldwide during the COVID-19 pandemic.…”

Section: Discussionmentioning

confidence: 99%

“…Our study is unique in its capacity to capture all government-subsidised anti-cancer medicines, in contrast to existing studies that have only captured recently approved medicines (thereby excluding most cytotoxic chemotherapy), or only reported on treatment attendances. [25] , [26] , [27] , [28] The PBS funds all medicines dispensed through community pharmacies and hospital outpatient oncology units. The overwhelming majority of systemic cancer therapy is administered in hospital outpatient oncology units, so our data provides a comprehensive picture of treatment patterns in Australia and across different treatment delivery settings.…”

Section: Discussionmentioning

confidence: 99%

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Changes in systemic cancer therapy in Australia during the COVID-19 pandemic: a population-based study

Tang

Daniels

Aslam

et al. 2021

The Lancet Regional Health - Western Pacific

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Background Since the emergence of COVID-19 there have been increasing global concerns about delays and/or discontinuations in cancer care. However, it is unclear to what extent systemic cancer therapy was impacted by COVID-19 in countries with relatively low COVID-19 infection rates. We examined changes in systemic cancer therapy in Australia during the COVID-19 pandemic. Methods We conducted a national observational study using de-identified records of government-subsidised cancer medicines dispensed to a random 10% sample of Australians between January 2017 to December 2020. We reported monthly dispensing and initiation rates of antineoplastic (chemo-, immuno- and targeted therapy), endocrine and supportive medicines per 100,000 population. We reported monthly discontinuation rates (defined as ≥90 days gap between cancer medicine dispensings) per 1,000 people treated. We used interrupted time series analysis to examine changes during times of increased COVID-19 risk and related public health measures (March, April and July 2020). Findings Between January 2017 and December 2020, 1,011,255 cancer medicines were dispensed to 51,515 people. Overall, there were no reductions in antineoplastic dispensing or initiation during the COVID-19 pandemic. In March 2020, we observed a temporary increase of 39/100,000 (95% CI: 14 to 65/100,000) in antineoplastic dispensing, driven by immunotherapy and targeted therapy. In April 2020, we observed a temporary decrease in chemotherapy initiation (-2/100,000, 95% CI: -4 to -1/100,000) and temporary increase in discontinuation of all antineoplastic medicines (35/1,000, 95% CI: 20 to 51/1,000), but these changes were not sustained. Interpretation The effective control of COVID-19 in Australia appears to have mitigated the initial impact of COVID-19 on systemic cancer therapy. We observed only small and temporary changes in the use of some cancer medicines early in the pandemic. Funding National Health and Medical Research Council; National Breast Cancer Foundation; Translational Cancer Research Network, supported by the Cancer Institute NSW.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Changes in systemic cancer therapy in Australia during the COVID-19 pandemic: a population-based study

Tang

Daniels

Aslam

et al. 2021

The Lancet Regional Health - Western Pacific

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“…It is important to note that there was a change in triage outcome in 2020, which likely represents the impact of the Covid-19 pandemic on SACT delivery in Scotland 8 . During this year, a greater proportion of patients received advice only which may represent not only a propensity to avoid patients coming to a high-risk clinical area but also a tendency for clinicians at the beginning of the pandemic to dose deescalate, use increased supportive measures and dose delay.…”

Section: Discussionmentioning

confidence: 99%

The Cancer Treatment Helpline – a retrospective study of the NHS Tayside Experience

Trip

George

Thomson

et al. 2021

Preprint

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Background: Treatment related toxicity and delays in the management of this toxicity can impact cancer patient outcomes. In Scotland, a national cancer helpline was established to provide triage assessment for patients receiving systemic anticancer therapy (SACT) in an attempt to minimize delays in toxicity management. In this article we describe the use and impact of the helpline in our region over the last 5 years.Methods: Patients who contacted the NHS Tayside cancer helpline between the 1st January 2016 and 31st December 2020 were retrospectively identified. Patient demographics as well as the reason and outcome of each call was recorded. A descriptive analysis was performed.Results: 6,562 individual patients received SACT and 8,397 calls were recorded during the time period. Median age of callers was 63 years (range 17-98) and 59.2% were female. Use of the helpline increased by 83.6% between 2016 and 2020, driven by an increase in in-hours calls. 41% of calls required review by a healthcare professional only, 24% required review and admission and the remaining 35% telephone advice only. The majority of cases (85%) were either assessed or advised solely by oncology. The proportional use of General Practitioner services has decreased. Conclusions: The helpline provides a way for patients to report symptoms directly to their clinical team and receive appropriate specialist advice at an early stage. We demonstrate that most of these calls can be managed solely by our oncology team. This system can reduce pressure on other parts of the local health system.

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“…It is important to note that there was a change in triage outcome in 2020, which likely represents the impact of the COVID-19 pandemic on SACT delivery in Scotland. 9 During this year, a greater proportion of patients received advice only which may represent not only a propensity to avoid patients coming to a high-risk clinical area but also a tendency for clinicians at the beginning of the pandemic to dose de-escalate, use increased supportive measures and dose delay. All of these measures would reduce incidence and severity of toxicity.…”

Section: Discussionmentioning

confidence: 99%

Cancer Treatment Helpline: a retrospective study of the NHS Tayside experience

et al. 2021

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BackgroundTreatment-related toxicity and delays in the management of this toxicity can impact the outcomes of patient with cancer. In Scotland, a national cancer helpline was established to provide triage assessment for patients receiving systemic anticancer therapy (SACT) in an attempt to minimise delays in toxicity management. In this article, we describe the use and impact of the helpline in our region over the last 5 years.MethodsPatients who contacted the NHS Tayside cancer helpline between 1 January 2016 and 31 December 2020 were retrospectively identified. Patient demographics as well as the reason and outcome of each call was recorded. A descriptive analysis was performed.Results6562 individual patients received SACT and 8385 calls were recorded during the time period. Median age of callers was 63 years (range 17–98) and 59.2% were women. Use of the helpline increased by 83.6% between 2016 and 2020, driven by an increase in in-hours calls. 41% of calls required review by a healthcare professional only, 24% required review and admission and the remaining 35% telephone advice only. The majority of cases (85%) were either assessed or advised solely by oncology. The proportional use of general practitioner services has decreased.ConclusionsThe helpline provides a way for patients to report symptoms directly to their clinical team and receive appropriate specialist advice at an early stage. We demonstrate that most of these calls can be managed solely by our oncology team. This system can reduce pressure on other parts of the local health system.

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The impact of COVID-19 on systemic anticancer treatment delivery in Scotland

Cited by 28 publications

References 10 publications

Changes in systemic cancer therapy in Australia during the COVID-19 pandemic: a population-based study

Changes in systemic cancer therapy in Australia during the COVID-19 pandemic: a population-based study

The Cancer Treatment Helpline – a retrospective study of the NHS Tayside Experience

Cancer Treatment Helpline: a retrospective study of the NHS Tayside experience

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