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14-10-2021 | Oncology | News | Article

Cancer surgery systems need strengthening against future societal lockdowns

Author: Laura Cowen

medwireNews: Data form the international COVIDSurg collaborative study show that around one in seven patients did not undergo planned surgery for cancer if their region was in full COVID-19 lockdown.

This shows that “[d]uring current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long-term investment in surge capacity for acute care during public health emergencies to protect elective staff and services,” write Aneel Bhangu (University of Birmingham, UK) and co-authors in The Lancet Oncology.

Their prospective cohort study included 20,006 adults with 15 cancer types who had a decision for curative surgery at one of 466 hospitals in 61 countries during the COVID-19 pandemic. The most common tumor types were breast (19.5%), head and neck (17.6%), colon (17.1%), and gynecologic (10.8%).

After a median 23 weeks of follow-up, 10.0% of participants had not received surgery, report Bhangu and team. In the 2001 non-operated individuals with available data, there was at least one COVID-19-related reason given for non-operation.

Using average national Oxford COVID-19 Stringency Index scores, which define the government response to COVID-19 for each patient during the period they awaited surgery, the researchers revealed that individuals in full (n=11,827) or moderate (n=3646) lockdowns had a significant 49% and 19% lower likelihoods of operation, respectively, than those in light lockdowns (n=4521). The corresponding non-operation rates were 15.0%, 5.5%, and 0.6%.

Further analysis revealed that being in a low-middle income country, increasing frailty, comorbidity, and having locally advanced or nodal disease were all independently associated with increased likelihood of non-operation.

“Identifying at-risk groups allows targeted system strengthening during both COVID-19 lockdowns and future pandemics,” Bhanghu et al remark.

The researchers also found that waiting for at least 5–6 weeks for surgery in full lockdown was associated with a significant 14% lower odds of being operated on than waiting 0 weeks.

Furthermore, the rate of surgeries occurring beyond 12 weeks of diagnosis in people not given neoadjuvant therapy was 23.8% during full lockdowns, compared with 10.4% and 9.1% during moderate or light lockdowns, respectively.

Bhangu and colleagues conclude that their study “has revealed the fragility of elective cancer surgery systems to lockdowns, particularly health systems in lower-middle-income countries.”

They say the findings “could inform policy makers’ planning regarding the collateral effects of societal restrictions,” and stress that “[c]apacity for major elective cancer [surgery] should be part of every country’s strategy to address whole-population health needs and prevent further collateral harm.”

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2021 Springer Healthcare Ltd, part of the Springer Nature Group

14 October 2021: The coronavirus pandemic is affecting all healthcare professionals across the globe. Medicine Matters’ focus, in this difficult time, is the dissemination of the latest data to support you in your research and clinical practice, based on the scientific literature. We will update the information we provide on the site, as the data are published. However, please refer to your own professional and governmental guidelines for the latest guidance in your own country.

Lancet Oncol 2021; doi:10.1016/S1470-2045(21)00493-9

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