Introduction: The COVID-19 pandemic caused by the novel coronavirus SARS-CoV-2 has put an unprecedented burden on global healthcare, including detrimental implications for the volume and provision of surgical services. The aim of this audit was to assess if the planned surgical cancer care (both diagnostic for possible cancer, and treatment of known cancer) during this period of widespread community and hospital based COVID-19 infection resulted in patients acquiring symptomatic COVID-19 as a consequence of their surgical admission, and if so, what the impact on patients was. Methods: A prospective audit of all patients undergoing elective cancer surgery in Greater Manchester operated on between 01/05/2020 and 31/06/2020 was undertaken after the introduction of specific peri operative COVID safety measures across Greater Manchester cancer surgical cells. The COVID related outcomes for all cancer patients operated on in Greater Manchester were recorded. Results: Of the 1501 patients undergoing surgery, one (<0.1%) was diagnosed with COVID-19 in hospital within 14 days of surgery. This patient did not require admission to critical care due to post-operative COVID-19 diagnosis, and there was no associated mortality related to post-operative COVID-19 infection. Conclusion: The use of peri operative COVID-19 infection prevention strategies has allowed for the safe continuation of elective cancer surgery during this pandemic in all surgical units, without significant additional COVID-19 related morbidity or mortality.

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Lung cancer is the single biggest cause of cancer death. The diagnostic pathway can be complex, including specialist cancer diagnostics that are not performed at every hospital. One such example is endobronchial ultrasound (EBUS), a day-case bronchoscopic procedure used for nodal staging and tissue diagnosis. In this proof-of-concept pilot in Greater Manchester, we tested a novel digital EBUS booking platform. This platform was accessible across multiple acute care trusts and provided visibility of all available EBUS appointments, allowing referring teams to book directly into the appropriate slot. During a 6-month pilot, 193 EBUS procedures were booked through this new single-queue platform. The median waiting times reduced by 2 days from 9 to 7 days (22% reduction and saving approximately 386 days in total) and reduced variation in waiting times by 1 day from 5 to 4 days (20% reduction). 98% of patients who completed an experience of care survey felt the process was ‘very well’ or ‘well’ organised and 77% felt the most important factor in deciding where to have their EBUS was the earliest possible appointment regardless of travel. This proof-of-concept pilot has shown improvements in cancer waiting times with significant future potential in delivering specialist cancer diagnostics.