Centro Universitário São Camilo (CUSC), São Paulo, Brazil.
Centre of Health Technology Assessment, Hospital Sírio-Libanês, São Paulo, Brazil.
JCO Glob Oncol. 2021 Feb;7:342-352. doi: 10.1200/GO.20.00632.
Delays and disruptions in health systems because of the COVID-19 pandemic were identified by a previous systematic review from our group. For improving the knowledge about the pandemic consequences for cancer care, this article aims to identify the effects of mitigation strategies developed to reduce the impact of such delays and disruptions.
Systematic review with a comprehensive search including formal databases, cancer and COVID-19 data sources, gray literature, and manual search. We considered clinical trials, observational longitudinal studies, cross-sectional studies, before-and-after studies, case series, and case studies. The selection, data extraction, and methodological assessment were performed by two independent reviewers. The methodological quality of the included studies was assessed by specific tools. The mitigation strategies identified were described in detail and their effects were summarized narratively.
Of 6,692 references reviewed, 28 were deemed eligible, and 9 studies with low to moderate methodological quality were included. Five multiple strategies and four single strategies were reported, and the possible effects of mitigating delays and disruptions in cancer care because of COVID-19 are inconsistent. The only comparative study reported a 48.7% reduction observed in the number of outpatient visits to the hospital accompanied by a small reduction in imaging and an improvement in radiation treatments after the implementation of a multiple organizational strategy.
The findings emphasize the infrequency of measuring and reporting mitigation strategies that specifically address patients' outcomes and thus a scarcity of high-quality evidence to inform program development. This review reinforces the need of adopting standardized measurement methods to monitor the impact of the mitigation strategies proposed to reduce the effects of delays and disruptions in cancer health care because of COVID-19.
本研究旨在确定为减轻这些延迟和中断的影响而制定的缓解策略的效果，这是我们团队之前的一项系统评价所确定的由于 COVID-19 大流行而导致的卫生系统延迟和中断。为了提高对大流行对癌症护理影响的认识，本文旨在确定为减轻这些延迟和中断的影响而制定的缓解策略的效果。
系统评价，全面检索包括正式数据库、癌症和 COVID-19 数据源、灰色文献和手动检索。我们考虑了临床试验、观察性纵向研究、横断面研究、前后研究、病例系列和病例研究。两名独立评审员进行了选择、数据提取和方法学评估。使用特定工具评估纳入研究的方法学质量。详细描述了确定的缓解策略，并以叙述性方式总结了它们的效果。
在审查的 6692 篇参考文献中，有 28 篇被认为符合条件，其中有 9 项研究的方法学质量为低到中度，报告了 5 项多种策略和 4 项单一策略，缓解 COVID-19 对癌症护理的延迟和中断的可能效果不一致。唯一的比较研究报告称，实施多种组织策略后，医院门诊就诊次数减少了 48.7%，同时影像学检查减少，放射治疗得到改善。
研究结果强调了很少有测量和报告专门针对患者结局的缓解策略，因此缺乏高质量证据来为方案制定提供信息。本综述强调了需要采用标准化的测量方法来监测为减轻 COVID-19 对癌症医疗保健的延迟和中断影响而提出的缓解策略的效果。
