Fox Louis, Monroy-Iglesias Maria J, Aggarwal Ajay, Haire Kate, Purushotham Arnie, Spicer James, Papa Sophie, Rigg Anne, Dolly Saoirse, Sullivan Richard, Van Hemelrijck Mieke
King's College London, School of Cancer and Pharmaceutical Sciences, Translational Oncology & Urology Research (TOUR), London, UK.
King's College London, School of Cancer and Pharmaceutical Sciences, Translational Oncology & Urology Research (TOUR), London, UK.
J Cancer Policy. 2022 Mar;31:100316. doi: 10.1016/j.jcpo.2021.100316. Epub 2021 Dec 8.
The COVID-19 pandemic has been highly disruptive for cancer care. Here, we examined the effect COVID-19 had on performance of the 62-day Cancer Waiting Time (CWT) target set by the National Health Service (NHS) in England.
Data were retrospectively obtained on COVID-19 hospitalisations and CWT for NHS hospitals in England (n = 121). We produced a 'COVID-19 burden' to describe the proportion of each provider's beds occupied with COVID-19 patients. COVID-19 burden was examined against CWT performance for 1st April - 30th May 2020 (Wave 1), and 1st October - 30th November 2020 (Wave 2). Two-tailed Spearman correlations were used to identify relationships between COVID-19 burden and CWT performance amongst different referral (i.e., 2-week-wait (2 W W) and internal specialist) and tumour types. Significantly correlated variables were further examined using linear regression models.
COVID-19 burden was negatively associated with the percentage of 2 W W pathway referrals that met the CWT target in Wave 1 (r= -0.30, p = 0.001) and Wave 2 (r= -0.21, p = 0.02). These associations were supported by the results from our linear regression models (B for wave 1: -0.71; 95 %CI: -1.03 to -0.40; B for wave 2: -0.38; 95 %CI: -0.68 to -0.07). No associations were found between COVID-19 burden and internal specialist referrals or tumour type.
Increased COVID-19 burden was associated with lower compliance with CWT targets amongst urgent referrals from primary care in England. This will likely be an ongoing issue due to the backlog of patients awaiting investigations and treatment.
As the number of cancer referrals improve, we highlight the need for changes to primary and secondary care to manage the backlog within cancer diagnostic services to alleviate the impact of COVID-19.
新冠疫情对癌症护理造成了极大干扰。在此，我们研究了新冠疫情对英国国家医疗服务体系（NHS）设定的62天癌症等待时间（CWT）目标达成情况的影响。
回顾性获取了英格兰NHS医院（n = 121）的新冠住院病例和CWT数据。我们计算了一个“新冠负担”指标，以描述每家医疗机构中新冠患者占用床位的比例。针对2020年4月1日至5月31日（第1波）以及2020年10月1日至11月30日（第2波）的CWT表现，对新冠负担进行了分析。使用双尾Spearman相关性分析来确定不同转诊类型（即两周等待（2WW）和内部专科转诊）以及肿瘤类型中新冠负担与CWT表现之间的关系。对于显著相关的变量，进一步使用线性回归模型进行分析。
新冠负担与第1波（r = -0.30，p = 0.001）和第2波（r = -0.21，p = 0.02）中达到CWT目标的2WW途径转诊百分比呈负相关。这些关联得到了我们线性回归模型结果的支持（第1波的B值：-0.71；95%置信区间：-1.03至-0.40；第2波的B值：-0.38；95%置信区间：-0.68至-0.07）。未发现新冠负担与内部专科转诊或肿瘤类型之间存在关联。
在英格兰，新冠负担增加与初级保健紧急转诊中CWT目标的较低达标率相关。由于等待检查和治疗的患者积压，这可能会是一个持续存在的问题。
随着癌症转诊数量的增加，我们强调需要对初级和二级医疗保健进行变革，以管理癌症诊断服务中的积压问题，减轻新冠疫情的影响。
