Pan-Birmingham Gynaecological Cancer Centre, Sandwell and West Birmingham Hospitals NHS Trust, City Hospital, Birmingham, UK.
Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
J Obstet Gynaecol. 2022 Nov;42(8):3692-3700. doi: 10.1080/01443615.2022.2153296. Epub 2022 Dec 5.
During the COVID-19 pandemic, reports of delays and alterations in cancer treatment pathways have emerged. We aim to evaluate the proportional impact of the pandemic over time on standard care delivery in a large tertiary gynaecological cancer centre. Consecutive patient records from weekly multidisciplinary team meetings were collected prospectively between 6 March 2020 and 26 March 2021. In total, 1943 patient discussions were held in our multidisciplinary team meetings during the study period, with 2.1% standard management decisions being altered due to the pandemic, the majority of which occurred during the first wave. Amongst alterations, 87.5% were deferral of surgery, and, in 62.5% of cases, were due to reduced critical care capacity. The majority of patients were offered alternative treatment, and surgery once resources permitted. During subsequent waves of COVID-19, with similar reductions in critical care capacity, we demonstrate avoidance of a second major increase in standard care pathway alterations.IMPACT STATEMENT Recent evidence has demonstrated significant delays to cancer surgery during the COVID-19 pandemic. However, few studies have objectively evaluated the quantity and nature of deviations from both surgical and non-surgical standard gynaecological cancer care pathways. We examined in detail the effects of the pandemic on tertiary gynaecological cancer service delivery in our centre. The main impact was in the ability to perform major surgery due to reduced critical care capacity. However, with the majority of standard care alterations clustered during the first wave of the pandemic, we demonstrate how the implementation of a COVID-19 mitigation plan minimised service disruption during subsequent waves. This study reinforces the importance of protecting gynaecological cancer services during situations where resources are limited. Having identified several key factors affected by the pandemic, we hope that our results will support others in coordinating responses to similar scenarios in future. Having not examined the effects of the pandemic on primary and secondary level cancer services, further research will be needed to evaluate the overall impact on long term patient outcomes.
在 COVID-19 大流行期间，已经出现了有关癌症治疗途径延迟和改变的报告。我们旨在评估大流行在一段时间内对大型三级妇科癌症中心标准护理的实施产生的比例影响。在 2020 年 3 月 6 日至 2021 年 3 月 26 日期间，每周多学科团队会议连续前瞻性地收集了连续患者记录。在研究期间，我们的多学科团队会议共进行了 1943 次患者讨论，由于大流行，标准管理决策中有 2.1%发生了改变，其中大多数发生在第一波。在改变中，87.5%是手术的推迟，并且在 62.5%的情况下，是由于危急护理能力的降低。大多数患者都提供了替代治疗方法，并在资源允许时进行手术。在随后的 COVID-19 浪潮中，由于危急护理能力相似地降低，我们避免了标准护理途径改变的第二次重大增加。
影响陈述 最近的证据表明，在 COVID-19 大流行期间，癌症手术明显延迟。然而，很少有研究客观地评估了从妇科癌症手术和非手术标准护理途径偏离的数量和性质。我们详细检查了大流行对我们中心三级妇科癌症服务提供的影响。主要影响是由于危急护理能力降低而无法进行主要手术。但是，由于大流行的第一波中集中了大多数标准护理的改变，我们展示了如何实施 COVID-19 缓解计划，以最大程度地减少后续浪潮中的服务中断。这项研究强调了在资源有限的情况下保护妇科癌症服务的重要性。我们已经确定了受大流行影响的几个关键因素，希望我们的结果将支持其他人在未来类似情况下协调应对措施。由于没有研究大流行对初级和二级癌症服务的影响，因此需要进一步研究来评估对长期患者结局的总体影响。
