Pandemic-Related Delays in Cancer Surgery May Not Affect Short-Term Outcomes

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Lockdowns and restrictions due to the COVID-19 pandemic led to delays in cancer surgeries, but this did not seem to affect short-term outcomes for most patients, according to a study published in The Lancet Oncology.

The CovidSurg-Can study (ClinicalTrials.gov Identifier: NCT04384926) was open to any hospital performing elective cancer surgery in an area affected by the COVID-19 pandemic.

The study included 20,006 adults scheduled for curative surgery at 466 hospitals in 61 countries. Patients had 1 of 15 solid tumor malignancies, the most common of which were breast (19.5%), head and neck (17.6%), colon (17.1%), and gynecologic (10.8%) cancers.


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Patients were scheduled for surgery 3 months from the local emergence of COVID-19 (January 21-April 14, 2020), and their care was followed until surgery or August 31, 2020.

A majority of patients (59.1%) were awaiting surgery during full lockdowns, 22.6% during a period of light restrictions, and 18.2% during moderate lockdowns.

Nonoperation Rate

At a median follow-up of 23 weeks, 10.0% of patients (n=2003) had not undergone a planned surgery. All of these patients had a reason related to COVID-19 for not undergoing surgery, but 15.3% also had at least 1 non-COVID-19-related reason.

Full lockdowns were associated with a 15.0% non-operation rate, moderate lockdowns with a 5.5% rate, and light restrictions with a 0.6% non-operation rate.

Among the patients who did not undergo surgery, 22.6% had been formally restaged at last follow-up, 8.9% had progressed to unresectable disease, and 2.4% died before their planned surgery. Causes of death included COVID-19-related complications (n=14) and non-COVID-19-related causes (n=34).

Delayed Surgery

There were 15,622 patients who went straight to surgery without receiving neoadjuvant therapy.

In this group, full lockdowns were associated with 23.8% of patients not having surgery within 12 weeks of diagnosis. That percentage fell to 10.4% for patients under moderate lockdowns and 9.1% for those under light restrictions.

However, the researchers noted that postoperative histopathological and clinical outcomes were similar among patients under light restrictions, moderate lockdowns, and full lockdowns.

Furthermore, there was no increase in unresectable disease, new metastatic disease, or 30-day mortality associated with increasing surgical delays.

The rate of new metastatic disease was 1.9% for patients who underwent surgery 0-4 weeks from diagnosis and 1.6% for those who underwent surgery more than 12 weeks from diagnosis. The rate of unresectable disease was 3.7% and 1.9%, respectively. The 30-day mortality rate was 1.5% and 1.1%, respectively.

“Although short-term oncological outcomes were not compromised in those selected for surgery, delays and nonoperations might lead to long-term reductions in survival,” the researchers wrote.

“During 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,” they added.

Reference

COVIDSurg Collaborative. Effect of COVID-19 pandemic lockdowns on planned cancer surgery for 15 tumour types in 61 countries: An international, prospective, cohort study.  Lancet Oncol. Published online October 5, 2021. doi:10.1016/S1470-2045(21)00493-9



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