One in seven patients missed cancer surgery during lockdowns: Lancet study
One in seven patients missed planned cancer surgery during the lockdown, a new study published in The Lancet Oncology has found. While immediate and short-term outcomes were not compromised, there could be a reduction in long-term survival among patients, who had delayed or cancelled surgeries, the study said.
A cohort of 20,006 patients, including 1,566 from India, with 15 types of cancers was followed up for the study. These patients were under treatment in 466 hospitals across 61 countries and had a decision for curative surgery during the pandemic. They were followed up until the point of surgery or till they stopped the follow-up up to August 31, 2020.
“Of eligible patients awaiting surgery, 2003 or 10% of 20,006 did not receive surgery after a median follow-up of 23 weeks, all of whom had a Covid-related reason given for non-operation,” said the study led by experts from the University of Birmingham. As many as 5,000 surgeons and anaesthetists from across the world collaborated on it.
Of the 2,003 non-operated patients, 453 patients were formally re-staged and 179 had progressed to unresectable disease. At least 48 patients died before their planned surgery – 14 due to Covid related complications and 34 due to non-Covid related causes. It was observed that increasing cases of Covid-19 were associated with increased rates of non-operation. Both moderate and full lockdowns were consistently associated with an increased likelihood of non-operation.
“Accessing healthcare facilities was difficult for patients during lockdown restrictions,” said Dr Shailesh Shrikhande, deputy director of Mumbai’s Tata Memorial Hospital (TMH) and one of the collaborators in the study. “There was also fear about Covid-19 infection and lack of information among patients that may have resulted in the delay,” he said.
TMH is one of the biggest cancer centres in the country that registered an average of 80,000 new patients annually before the pandemic. In 2020, when the pandemic hit Mumbai, TMH saw a decline in footfall with 62,000 registrations. The hospital, however, took the lead in starting elective surgeries amid the pandemic, by scientifically and strategically choosing patients. “Cancer will not wait for Covid-19 to disappear. We have to therefore plan our hospitals well and triage well in order to face such challenges in the future,” said Shrikhande. He said that even as the Mumbai centre recorded a decline in registrations, newly developed hospitals under the Tata Memorial Centre in other cities recorded an uptick during the pandemic. This suggested that patients opted to get treatment at local or nearest centres as travelling to Mumbai was difficult due to the lockdown.
Dr Nikhil Agrawal, a gastrointestinal cancer surgeon at Max Superspeciality Hospital in Delhi, also a collaborator to the Lancet study, said, “We should strengthen our cancer care delivery pathways for future shocks like the Covid-19 pandemic.”
From operating nearly 200 patients a month, the surgical oncology department at Max Superspeciality Hospital came down to performing only about 10% to 20% of procedures when the pandemic hit in 2020. “As we got to know more about the virus and the infection, we put systems in place and the number of operations slowly went back to the normal average,” said Agrawal, adding the surgery numbers were again affected during the second wave when Delhi struggled with Intensive Care Unit beds and oxygen supply.
The Lancet study, too, emphasised the need to strengthen the resilience of elective surgery systems. “In order to prevent further harm during future lockdowns, we must make the systems around elective surgery more resilient – protecting elective surgery beds and operating theatre space, and properly resourcing ‘surge’ capacity for periods of high demand on the hospital, whether that is Covid, the flu or other public health emergencies,” James Glasbey, co-lead author of the study from the University of Birmingham said in a media release.