Background Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index <20), moderate lockdowns (20–60), and full lockdowns (>60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov , NCT04384926 . Findings Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include...

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Background With increasing cancer diagnoses and survivorship the burden on the MDT meeting is increasing and mechanisms are sought to optimise discussion. Streamlining straightforward cases to registration and audit, rather than discussion, has been suggested. This is currently used in the East of Scotland but not in the West. Here we propose a method of streamlining in uro-oncology MDTs and assess the potential impact this would have on Greater Glasgow and Clyde. Methods Local and national guidance was reviewed and ongoing clinical trials were considered when defining potential streamlining criteria defined (Figure). These criteria were then applied to 100 consecutive cases of prostate, renal and bladder cancer discussed at the Greater Glasgow and Clyde MDTs. Results 8% of renal, 24% of prostate and 24% of bladder cancers could be streamlined. Patient specific factors meant 2% of renal, 4% of prostate and 3% bladder cases, although eligible on disease criteria, could not be streamlined. There was insufficient information to reach a decision in 7% of all cases. Conclusion Streamlining cases to registration rather than discussion would reduce the burden on meeting time. An understanding of patient specific factors is necessary as protocolising based on disease criteria alone is not appropriate for all. Streamline criteria need refinement, testing and agreement, ideally nationally, and we acknowledge the process has some drawbacks, including quality of referral information and time burden of vetting the list. [Formula: see text]

AbstractsArch Dis Child 2013;98(Suppl 1):A1-A117 A95Objective There is conflicting evidence on the association between television viewing in childhood and cognition. No recent UK and few worldwide studies have looked at the longer-term effects of television viewing in childhood. This study investigates the association between verbal and non-verbal cognitive outcomes at 7 years and television habits at 3, 5 and 7 years. Method The study comprises longitudinal and cross-sectional analysis of the United Kingdom Millennium Cohort Study based on 8,148 children with complete data on variables of interest, maternal reports of television viewing and scores from objective tests of cognitive ability (British Ability Scales Second Edition) collected when cohort members were 3, 5 and 7 years. Mean ability scores were converted into the equivalent progress expected in a child at each age group using existing age equivalents derived for the cohort study population. Linear regression was used to estimate the relationship between each subscale and categories of television viewing (in relation to a reference group who watched between 1-3 hours of television a weekday) after adjustment for co-variates.Results Children who did not watch television at 3 years had verbal ability scores at 7 years approximately 7 months behind the reference group (p < 0.05); their non-verbal ability skills were approximately 18months delayed (p < 0.05). Children who watched less than 1hour a weekday had delayed non-verbal skills of approximately 2 months (p < 0.05).There was no significant association between television viewing at 5 and verbal or non-verbal ability at 7 years.Children who did not watch television at 7 years had verbal ability scores approximately 3 months ahead of the reference group (p < 0.05). Those who watched less than 1hour a weekday were approximately 1month ahead (p < 0.05). Children who watched over 3 hours of television a weekday had delays of more than 1month (p < 0.05). There was no significant association between television viewing at 7years and non-verbal ability. Conclusion There was a positive association between television viewing at 3 years and verbal and non-verbal cognition at 7 years in this cohort but a negative association between television viewing at 7 years and verbal skills at 7 years. This may influence potential guidance on television viewing. Possible explanations are the type of programmes watched or accumulation of viewing hours.