Prioritization of Surgery in Cancer Patients During the COVID-19 Pandemic: Lessons From a Failed Balancing Act

Overview

Journal Ann Surg Open

Publisher Wolters Kluwer

Specialty General Surgery

Date 2023 Aug 28

PMID 37637874

Authors

Vincent Donckier

Antonio Estache

Gabriel Liberale

Michel Goldman

Affiliations

Soon will be listed here.

Abstract

The prioritization of surgical oncology over other elective interventions during COVID-19 has failed to preserve the quality of care in oncology and will likely lead to an increase of cancer-related mortality in the coming years. We propose five components for systems to improve the organization of surgical oncology during future crises, namely (1) a multidisciplinary governance structure employing predictive models and risk/benefit evaluations, (2) predefined quality objectives based on measurable markers (regularly reviewed and adapted), (3) temporary flexibility in therapeutic algorithms and authorization procedures (with associated safeguards), (4) systems to ensure access to transparent, apolitical information, and (5) explicit, dedicated logistical surgical capacities to optimize coordination and resource allocation.

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References

Peacock H, Tambuyzer T, Verdoodt F, Calay F, Poirel H, De Schutter H . Decline and incomplete recovery in cancer diagnoses during the COVID-19 pandemic in Belgium: a year-long, population-level analysis. ESMO Open. 2021; 6(4):100197. PMC: 8411068. DOI: 10.1016/j.esmoop.2021.100197. View

Abbasi K . Covid-19: politicisation, "corruption," and suppression of science. BMJ. 2020; 371:m4425. DOI: 10.1136/bmj.m4425. View

Cherny N, Sullivan R, Dafni U, Kerst J, Sobrero A, Zielinski C . A standardised, generic, validated approach to stratify the magnitude of clinical benefit that can be anticipated from anti-cancer therapies: the European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS). Ann Oncol. 2016; 28(11):2901-2905. DOI: 10.1093/annonc/mdw258. View

Sud A, Torr B, Jones M, Broggio J, Scott S, Loveday C . Effect of delays in the 2-week-wait cancer referral pathway during the COVID-19 pandemic on cancer survival in the UK: a modelling study. Lancet Oncol. 2020; 21(8):1035-1044. PMC: 7116538. DOI: 10.1016/S1470-2045(20)30392-2. View

Hanna T, Evans G, Booth C . Cancer, COVID-19 and the precautionary principle: prioritizing treatment during a global pandemic. Nat Rev Clin Oncol. 2020; 17(5):268-270. PMC: 7117554. DOI: 10.1038/s41571-020-0362-6. View

Maringe C, Spicer J, Morris M, Purushotham A, Nolte E, Sullivan R . The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population-based, modelling study. Lancet Oncol. 2020; 21(8):1023-1034. PMC: 7417808. DOI: 10.1016/S1470-2045(20)30388-0. View

Peltrini R, Imperatore N, Di Nuzzo M, DAmbra M, Bracale U, Corcione F . Effects of the first and second wave of the COVID-19 pandemic on patients with colorectal cancer: what has really changed in the outcomes?. Br J Surg. 2021; 108(11):e365-e366. PMC: 8499961. DOI: 10.1093/bjs/znab289. View

Bartlett D, Howe J, Chang G, Crago A, Hogg M, Karakousis G . Management of Cancer Surgery Cases During the COVID-19 Pandemic: Considerations. Ann Surg Oncol. 2020; 27(6):1717-1720. PMC: 7141488. DOI: 10.1245/s10434-020-08461-2. View

Wilkinson E . UK Government urged to recognise post-COVID-19 cancer backlog. Lancet Oncol. 2021; 22(7):910. PMC: 8584714. DOI: 10.1016/S1470-2045(21)00330-2. View

10.

Brindle M, Doherty G, Lillemoe K, Gawande A . Approaching Surgical Triage During the COVID-19 Pandemic. Ann Surg. 2020; 272(2):e40-e42. PMC: 7373445. DOI: 10.1097/SLA.0000000000003992. View

11.

Marron J, Joffe S, Jagsi R, Spence R, Hlubocky F . Ethics and Resource Scarcity: ASCO Recommendations for the Oncology Community During the COVID-19 Pandemic. J Clin Oncol. 2020; 38(19):2201-2205. DOI: 10.1200/JCO.20.00960. View

12.

de Cassio Zequi S, Franca Silva I, Duprat J, Coimbra F, Gross J, Vartanian J . Informed consent and a risk-based approach to oncologic surgery in a cancer center during the COVID-19 pandemic. J Surg Oncol. 2021; 123(8):1659-1668. PMC: 8251048. DOI: 10.1002/jso.26452. View

13.

DeBoer R, Fadelu T, Shulman L, Van Loon K . Applying Lessons Learned From Low-Resource Settings to Prioritize Cancer Care in a Pandemic. JAMA Oncol. 2020; 6(9):1429-1433. DOI: 10.1001/jamaoncol.2020.2976. View

14.

Emanuel E, Persad G, Upshur R, Thome B, Parker M, Glickman A . Fair Allocation of Scarce Medical Resources in the Time of Covid-19. N Engl J Med. 2020; 382(21):2049-2055. DOI: 10.1056/NEJMsb2005114. View

15.

Hanna T, King W, Thibodeau S, Jalink M, Paulin G, Harvey-Jones E . Mortality due to cancer treatment delay: systematic review and meta-analysis. BMJ. 2020; 371:m4087. PMC: 7610021. DOI: 10.1136/bmj.m4087. View

16.

Moletta L, Pierobon E, Capovilla G, Costantini M, Salvador R, Merigliano S . International guidelines and recommendations for surgery during Covid-19 pandemic: A Systematic Review. Int J Surg. 2020; 79:180-188. PMC: 7245259. DOI: 10.1016/j.ijsu.2020.05.061. View

17.

Santoro G, Grossi U, Murad-Regadas S, Nunoo-Mensah J, Mellgren A, Di Tanna G . DElayed COloRectal cancer care during COVID-19 Pandemic (DECOR-19): Global perspective from an international survey. Surgery. 2020; 169(4):796-807. PMC: 7670903. DOI: 10.1016/j.surg.2020.11.008. View

18.

Johnson B, Waddimba A, Ogola G, Fleshman Jr J, Preskitt J . A systematic review and meta-analysis of surgery delays and survival in breast, lung and colon cancers: Implication for surgical triage during the COVID-19 pandemic. Am J Surg. 2020; 222(2):311-318. PMC: 7834494. DOI: 10.1016/j.amjsurg.2020.12.015. View