Cancer surgery systems need strengthening against future societal lockdowns
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
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