Impact of COVID-19 Pandemic on Cancer Surgical Services—AIIMS, New Delhi Experience

Abstract

COVID pandemic has impacted cancer care delivery and cancer surgical services globally. There is an urgent need to study the extent of the impact of COVID on cancer surgery and individual institutional response and strategies adopted to counter the adverse impact. A review of administrative and clinical policy changes adopted at the tertiary cancer center to combat COVID pandemic and resume cancer surgical services were performed. A retrospective comparative analysis of cancer out-patient census during COVID pandemic affected year and the preceding normal year along with cancer surgery data audit for the same periods was performed to assess the impact of the pandemic on cancer surgery. In addition, COVID infection rates among cancer surgery patients and healthcare workers were evaluated. There was approximately a 50% reduction in cancer outpatient registrations during COVID pandemic affected year. A trend of increasing footfalls was noted with decreasing COVID intensity and opening of lockdowns. There was a 33% reduction in major elective surgery and a 41% reduction in emergency surgery performed during the COVID period. As far as cancer surgeries are concerned, there was a 12–50% reduction in volumes involving different subsites. Overall COVID positivity rates among cancer surgery patients was low (8.17%), and approximately 30% of healthcare workers involved in cancer surgery were tested positive for COVID during the study period. Results of the current study indicate a significant impact of COVID pandemic on cancer surgical services. There was a significant impact on outpatient visits and cancer surgery volumes. However, a multidisciplinary-coordinated team approach, effective administrative and policy implementation, adoption of revised surgical safety and anesthesia protocols, COVID screening, and testing protocols facilitated resumption of cancer surgical services without adverse impact on surgical outcomes.

Impact of the pandemic on surgical oncology in Piedmont, Italy: A retrospective observational study

“…Our results confirmed the impact of COVID-19 pandemic, especially during the early waves, similar to what has been documented in other countries. 3,4 In particular, the reduction we found was lower than the decrease of −33.9% (95% CI: −39.9; −27.9) in cancer surgical treatments administered during the pandemic globally, while it was more consistent with the reduction reported in Europe, that is, −20.9% (95% CI: −30.1; −11.7). 19 This heterogeneity is not limited to cross-country comparisons but it has been reported also within Italy, especially when considering surgeries for different cancer sites.…”

“…Worldwide, governments implemented containment policies and restrictive measures to limit the spread of the virus, impacting the general population 2 . The indirect effects of the COVID‐19 pandemic on cancer care and surgical services have been widely acknowledged, revealing a decrease in hospitalization volumes worldwide, 3–5 both for emergency and nonemergency access 6 . The surge in COVID‐19 cases has created a critical demand for intensive care, straining hospital resources and staff.…”

Comparison of demographic and clinical characteristics between pandemic and pre-pandemic period in non-COVID intensive care units: a retrospective study

“…[ 10 ] Yanaral and Öz reported that in the pandemic period, the number of patients undergoing emergency and elective surgery decreased compared to the pre-pandemic period. [ 11 ] Furthermore, Schöni et al, reported that surgical interventions decreased during the pandemic period. [ 12 ] Unlike the literature, in our study, the number of post-operative patients admitted to ICU was higher during the pandemic period.…”

Cancer surgery on the global stage: Updates and progress

“…[29][30][31][32] In India, in one hospital system in New Delhi, there was a 33.7% reduction in major cancer surgeries in 2020. 33 Unlike some other diseases, delays in cancer screening can lead to advanced disease at presentation, which can necessitate more complex surgical procedures that are associated with poor outcomes. The NCI predicted an additional 10,000 excess deaths over the next 10 years for breast and colorectal cancer patients due to delays in access to care during the COVID-19 pandemic.…”

“…There were reductions in the number of cancer surgeries, delays in radiotherapy and chemotherapy, as well as reductions in supply chains that were crucial for surgical equipment 29–32 . In India, in one hospital system in New Delhi, there was a 33.7% reduction in major cancer surgeries in 2020 33 …”