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Effect of COVID-19 pandemic lockdowns on planned cancer surgery for 15 tumour types in 61 countries: an international, prospective, cohort study

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 ligh... Full description

Journal Title: The lancet oncology 2021-11, Vol.22 (11), p.1507-1517
Main Author: Minaya-Bravo, Ana
Other Authors: Evans, Jonathan P , Wilkin, Richard JW , Smart, Neil J , Shu, Sebastian , Valenzuela, JI , Apas Perez de Nucci, A , Wong, E , Pockney, P , Waldron, A , Burtscher, J , Phillips, E , Campbell, L , Dare, A , Osman, F , Vargas Añazco, C , Puentes, LO , Calderon Quiroz, PH , Iversen, LH , El Kassas, M , Salem, H , Atta, R , Saifeldin, H , Martin, L , Pruvot, FR , Felli, E , Seeliger, B , Cathala, N , Levy-Zauberman, Y , Hölzle, F , Klimopoulos, S , Kalfountzos, C , Syllaios, A , Tsolakidis, D , Poonia, DR , Silodia, A , Najar, FA , Owens, P , Cullinane, C , Fagan, J , O'Malley, S , Ferrari, F , Tornese, S , Sorbi, F , Podda, M , Fares Bucci, A , Biglia, N , Montelatici, M , Peluso, C , Consorti, G , Hashimoto, D , Oguma, J , Alawami, A , Thanapal, MR , Egbuchulem, IK , Siddiqui, T , Akbar, A , I. A. Alzeerelhouseini, H , Dubienska, K , Chloupek, A , Teixeira, M , De Oliveira López, AL , Manso, MI , Soares, A , Silveira Nunes, I , Litvin, A , Semina, E , Nassif, M , Othman, E , Pavlov, M , Kajmakovic, B , Goran, M , Jevric, M , Savkovic, N , Ponce, S , Peña Soria, MJ , Romero de Diego, A , Ballester, E , Prieto Calvo, M , Pamias, J , Kara, H , Gönüllü, E , Manku, B , Chowdhry, MF , Henry, A , Kittur, M , Nunns, D , Pissanou, T , Abd Kahar, NN , Beasley, N , Fuwa, O , McIlmunn, C , Laurente, R , Chung, E , Hagger, R , Webber, L , Kalavrezos, N , Agarwal, K , Kazaure, H , Najarian, M
Format: Electronic Article Electronic Article
Language: eng ; nor
Subjects:
Adult
Aged
Aged, 80 and over
Analysis
Cancer
Cancer surgery
Communicable Disease Control - legislation & jurisprudence
Coronaviruses
COVID-19
COVID-19 - epidemiology
COVID-19 - prevention & control
Decision making
Diagnosis
Disease transmission
Elective surgery
Endoscopy
Female
Health aspects
Histopathology
Human health and pathology
Humans
Intestine
Life Sciences
Male
Medical research
Medicin och hälsovetenskap
Medicine, Experimental
Middle Aged
Neoplasms - classification
Neoplasms - epidemiology
Neoplasms - surgery
Outcome Assessment, Health Care
Pandemics
Patients
Proportional Hazards Models
Prospective Studies
Public health
Regression analysis
Sarcoma
SARS-CoV-2
Sensitivity analysis
Severe acute respiratory syndrome coronavirus 2
Surgery
Time-to-Treatment
Tumors
Withholding Treatment
World health
Publisher: England: Elsevier Ltd
ID: ISSN: 1470-2045
Zum Text:
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recordid: cdi_swepub_primary_oai_prod_swepub_kib_ki_se_234624250
title: Effect of COVID-19 pandemic lockdowns on planned cancer surgery for 15 tumour types in 61 countries: an international, prospective, cohort study
format: Article
creator:
  • Minaya-Bravo, Ana
  • Evans, Jonathan P
  • Wilkin, Richard JW
  • Smart, Neil J
  • Shu, Sebastian
  • Valenzuela, JI
  • Apas Perez de Nucci, A
  • Wong, E
  • Pockney, P
  • Waldron, A
  • Burtscher, J
  • Phillips, E
  • Campbell, L
  • Dare, A
  • Osman, F
  • Vargas Añazco, C
  • Puentes, LO
  • Calderon Quiroz, PH
  • Iversen, LH
  • El Kassas, M
  • Salem, H
  • Atta, R
  • Saifeldin, H
  • Martin, L
  • Pruvot, FR
  • Felli, E
  • Seeliger, B
  • Cathala, N
  • Levy-Zauberman, Y
  • Hölzle, F
  • Klimopoulos, S
  • Kalfountzos, C
  • Syllaios, A
  • Tsolakidis, D
  • Poonia, DR
  • Silodia, A
  • Najar, FA
  • Owens, P
  • Cullinane, C
  • Fagan, J
  • O'Malley, S
  • Ferrari, F
  • Tornese, S
  • Sorbi, F
  • Podda, M
  • Fares Bucci, A
  • Biglia, N
  • Montelatici, M
  • Peluso, C
  • Consorti, G
  • Hashimoto, D
  • Oguma, J
  • Alawami, A
  • Thanapal, MR
  • Egbuchulem, IK
  • Siddiqui, T
  • Akbar, A
  • I. A. Alzeerelhouseini, H
  • Dubienska, K
  • Chloupek, A
  • Teixeira, M
  • De Oliveira López, AL
  • Manso, MI
  • Soares, A
  • Silveira Nunes, I
  • Litvin, A
  • Semina, E
  • Nassif, M
  • Othman, E
  • Pavlov, M
  • Kajmakovic, B
  • Goran, M
  • Jevric, M
  • Savkovic, N
  • Ponce, S
  • Peña Soria, MJ
  • Romero de Diego, A
  • Ballester, E
  • Prieto Calvo, M
  • Pamias, J
  • Kara, H
  • Gönüllü, E
  • Manku, B
  • Chowdhry, MF
  • Henry, A
  • Kittur, M
  • Nunns, D
  • Pissanou, T
  • Abd Kahar, NN
  • Beasley, N
  • Fuwa, O
  • McIlmunn, C
  • Laurente, R
  • Chung, E
  • Hagger, R
  • Webber, L
  • Kalavrezos, N
  • Agarwal, K
  • Kazaure, H
  • Najarian, M
subjects:
  • Adult
  • Aged
  • Aged, 80 and over
  • Analysis
  • Cancer
  • Cancer surgery
  • Communicable Disease Control - legislation & jurisprudence
  • Coronaviruses
  • COVID-19
  • COVID-19 - epidemiology
  • COVID-19 - prevention & control
  • Decision making
  • Diagnosis
  • Disease transmission
  • Elective surgery
  • Endoscopy
  • Female
  • Health aspects
  • Histopathology
  • Human health and pathology
  • Humans
  • Intestine
  • Life Sciences
  • Male
  • Medical research
  • Medicin och hälsovetenskap
  • Medicine, Experimental
  • Middle Aged
  • Neoplasms - classification
  • Neoplasms - epidemiology
  • Neoplasms - surgery
  • Outcome Assessment, Health Care
  • Pandemics
  • Patients
  • Proportional Hazards Models
  • Prospective Studies
  • Public health
  • Regression analysis
  • Sarcoma
  • SARS-CoV-2
  • Sensitivity analysis
  • Severe acute respiratory syndrome coronavirus 2
  • Surgery
  • Time-to-Treatment
  • Tumors
  • Withholding Treatment
  • World health
ispartof: The lancet oncology, 2021-11, Vol.22 (11), p.1507-1517
description: 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. 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 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. 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
language: eng ; nor
source:
identifier: ISSN: 1470-2045
fulltext: no_fulltext
issn:
  • 1470-2045
  • 1474-5488
  • 1474-5488
url: Link


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titleEffect of COVID-19 pandemic lockdowns on planned cancer surgery for 15 tumour types in 61 countries: an international, prospective, cohort study
creatorMinaya-Bravo, Ana ; Evans, Jonathan P ; Wilkin, Richard JW ; Smart, Neil J ; Shu, Sebastian ; Valenzuela, JI ; Apas Perez de Nucci, A ; Wong, E ; Pockney, P ; Waldron, A ; Burtscher, J ; Phillips, E ; Campbell, L ; Dare, A ; Osman, F ; Vargas Añazco, C ; Puentes, LO ; Calderon Quiroz, PH ; Iversen, LH ; El Kassas, M ; Salem, H ; Atta, R ; Saifeldin, H ; Martin, L ; Pruvot, FR ; Felli, E ; Seeliger, B ; Cathala, N ; Levy-Zauberman, Y ; Hölzle, F ; Klimopoulos, S ; Kalfountzos, C ; Syllaios, A ; Tsolakidis, D ; Poonia, DR ; Silodia, A ; Najar, FA ; Owens, P ; Cullinane, C ; Fagan, J ; O'Malley, S ; Ferrari, F ; Tornese, S ; Sorbi, F ; Podda, M ; Fares Bucci, A ; Biglia, N ; Montelatici, M ; Peluso, C ; Consorti, G ; Hashimoto, D ; Oguma, J ; Alawami, A ; Thanapal, MR ; Egbuchulem, IK ; Siddiqui, T ; Akbar, A ; I. A. Alzeerelhouseini, H ; Dubienska, K ; Chloupek, A ; Teixeira, M ; De Oliveira López, AL ; Manso, MI ; Soares, A ; Silveira Nunes, I ; Litvin, A ; Semina, E ; Nassif, M ; Othman, E ; Pavlov, M ; Kajmakovic, B ; Goran, M ; Jevric, M ; Savkovic, N ; Ponce, S ; Peña Soria, MJ ; Romero de Diego, A ; Ballester, E ; Prieto Calvo, M ; Pamias, J ; Kara, H ; Gönüllü, E ; Manku, B ; Chowdhry, MF ; Henry, A ; Kittur, M ; Nunns, D ; Pissanou, T ; Abd Kahar, NN ; Beasley, N ; Fuwa, O ; McIlmunn, C ; Laurente, R ; Chung, E ; Hagger, R ; Webber, L ; Kalavrezos, N ; Agarwal, K ; Kazaure, H ; Najarian, M
creatorcontribMinaya-Bravo, Ana ; Evans, Jonathan P ; Wilkin, Richard JW ; Smart, Neil J ; Shu, Sebastian ; Valenzuela, JI ; Apas Perez de Nucci, A ; Wong, E ; Pockney, P ; Waldron, A ; Burtscher, J ; Phillips, E ; Campbell, L ; Dare, A ; Osman, F ; Vargas Añazco, C ; Puentes, LO ; Calderon Quiroz, PH ; Iversen, LH ; El Kassas, M ; Salem, H ; Atta, R ; Saifeldin, H ; Martin, L ; Pruvot, FR ; Felli, E ; Seeliger, B ; Cathala, N ; Levy-Zauberman, Y ; Hölzle, F ; Klimopoulos, S ; Kalfountzos, C ; Syllaios, A ; Tsolakidis, D ; Poonia, DR ; Silodia, A ; Najar, FA ; Owens, P ; Cullinane, C ; Fagan, J ; O'Malley, S ; Ferrari, F ; Tornese, S ; Sorbi, F ; Podda, M ; Fares Bucci, A ; Biglia, N ; Montelatici, M ; Peluso, C ; Consorti, G ; Hashimoto, D ; Oguma, J ; Alawami, A ; Thanapal, MR ; Egbuchulem, IK ; Siddiqui, T ; Akbar, A ; I. A. Alzeerelhouseini, H ; Dubienska, K ; Chloupek, A ; Teixeira, M ; De Oliveira López, AL ; Manso, MI ; Soares, A ; Silveira Nunes, I ; Litvin, A ; Semina, E ; Nassif, M ; Othman, E ; Pavlov, M ; Kajmakovic, B ; Goran, M ; Jevric, M ; Savkovic, N ; Ponce, S ; Peña Soria, MJ ; Romero de Diego, A ; Ballester, E ; Prieto Calvo, M ; Pamias, J ; Kara, H ; Gönüllü, E ; Manku, B ; Chowdhry, MF ; Henry, A ; Kittur, M ; Nunns, D ; Pissanou, T ; Abd Kahar, NN ; Beasley, N ; Fuwa, O ; McIlmunn, C ; Laurente, R ; Chung, E ; Hagger, R ; Webber, L ; Kalavrezos, N ; Agarwal, K ; Kazaure, H ; Najarian, M ; SpainSurg ; Association of Surgeons in Training ; Global Initiative for Children's Surgery ; Transatlantic Australasian Retroperitoneal Sarcoma Working Group ; COVIDSurg Collaborative ; Irish Surgical Research Collaborative ; Italian Society of Surgical Oncology ; ItSURG ; GlobalPaedSurg ; PTSurg ; Italian Society of Colorectal Surgery ; GlobalSurg
descriptionSurgery 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. 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. 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. 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 protected elective surgical pathways and long-term investment in surge capacity for acute care during public health emergencies to protect elective staff and services. National Institute for Health Research Global Health Research Unit, Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, Medtronic, Sarcoma UK, The Urology Foundation, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research.
identifier
0ISSN: 1470-2045
1ISSN: 1474-5488
2EISSN: 1474-5488
3DOI: 10.1016/S1470-2045(21)00493-9
4PMID: 34624250
languageeng ; nor
publisherEngland: Elsevier Ltd
subjectAdult ; Aged ; Aged, 80 and over ; Analysis ; Cancer ; Cancer surgery ; Communicable Disease Control - legislation & jurisprudence ; Coronaviruses ; COVID-19 ; COVID-19 - epidemiology ; COVID-19 - prevention & control ; Decision making ; Diagnosis ; Disease transmission ; Elective surgery ; Endoscopy ; Female ; Health aspects ; Histopathology ; Human health and pathology ; Humans ; Intestine ; Life Sciences ; Male ; Medical research ; Medicin och hälsovetenskap ; Medicine, Experimental ; Middle Aged ; Neoplasms - classification ; Neoplasms - epidemiology ; Neoplasms - surgery ; Outcome Assessment, Health Care ; Pandemics ; Patients ; Proportional Hazards Models ; Prospective Studies ; Public health ; Regression analysis ; Sarcoma ; SARS-CoV-2 ; Sensitivity analysis ; Severe acute respiratory syndrome coronavirus 2 ; Surgery ; Time-to-Treatment ; Tumors ; Withholding Treatment ; World health
ispartofThe lancet oncology, 2021-11, Vol.22 (11), p.1507-1517
rights
02021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license
1Copyright © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.
2COPYRIGHT 2021 Elsevier B.V.
32021. The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. This work is published under http://creativecommons.org/licenses/by-nc-nd/3.0/ (theLicense”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.
4info:eu-repo/semantics/openAccess
5Distributed under a Creative Commons Attribution 4.0 International License
lds50peer_reviewed
oafree_for_read
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creatorcontrib
0Minaya-Bravo, Ana
1Evans, Jonathan P
2Wilkin, Richard JW
3Smart, Neil J
4Shu, Sebastian
5Valenzuela, JI
6Apas Perez de Nucci, A
7Wong, E
8Pockney, P
9Waldron, A
10Burtscher, J
11Phillips, E
12Campbell, L
13Dare, A
14Osman, F
15Vargas Añazco, C
16Puentes, LO
17Calderon Quiroz, PH
18Iversen, LH
19El Kassas, M
20Salem, H
21Atta, R
22Saifeldin, H
23Martin, L
24Pruvot, FR
25Felli, E
26Seeliger, B
27Cathala, N
28Levy-Zauberman, Y
29Hölzle, F
30Klimopoulos, S
31Kalfountzos, C
32Syllaios, A
33Tsolakidis, D
34Poonia, DR
35Silodia, A
36Najar, FA
37Owens, P
38Cullinane, C
39Fagan, J
40O'Malley, S
41Ferrari, F
42Tornese, S
43Sorbi, F
44Podda, M
45Fares Bucci, A
46Biglia, N
47Montelatici, M
48Peluso, C
49Consorti, G
50Hashimoto, D
51Oguma, J
52Alawami, A
53Thanapal, MR
54Egbuchulem, IK
55Siddiqui, T
56Akbar, A
57I. A. Alzeerelhouseini, H
58Dubienska, K
59Chloupek, A
60Teixeira, M
61De Oliveira López, AL
62Manso, MI
63Soares, A
64Silveira Nunes, I
65Litvin, A
66Semina, E
67Nassif, M
68Othman, E
69Pavlov, M
70Kajmakovic, B
71Goran, M
72Jevric, M
73Savkovic, N
74Ponce, S
75Peña Soria, MJ
76Romero de Diego, A
77Ballester, E
78Prieto Calvo, M
79Pamias, J
80Kara, H
81Gönüllü, E
82Manku, B
83Chowdhry, MF
84Henry, A
85Kittur, M
86Nunns, D
87Pissanou, T
88Abd Kahar, NN
89Beasley, N
90Fuwa, O
91McIlmunn, C
92Laurente, R
93Chung, E
94Hagger, R
95Webber, L
96Kalavrezos, N
97Agarwal, K
98Kazaure, H
99Najarian, M
100SpainSurg
101Association of Surgeons in Training
102Global Initiative for Children's Surgery
103Transatlantic Australasian Retroperitoneal Sarcoma Working Group
104COVIDSurg Collaborative
105Irish Surgical Research Collaborative
106Italian Society of Surgical Oncology
107ItSURG
108GlobalPaedSurg
109PTSurg
110Italian Society of Colorectal Surgery
111GlobalSurg
title
0Effect of COVID-19 pandemic lockdowns on planned cancer surgery for 15 tumour types in 61 countries: an international, prospective, cohort study
1The lancet oncology
addtitleLancet Oncol
descriptionSurgery 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. 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. 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. 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 protected elective surgical pathways and long-term investment in surge capacity for acute care during public health emergencies to protect elective staff and services. National Institute for Health Research Global Health Research Unit, Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, Medtronic, Sarcoma UK, The Urology Foundation, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research.
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1Aged
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3Analysis
4Cancer
5Cancer surgery
6Communicable Disease Control - legislation & jurisprudence
7Coronaviruses
8COVID-19
9COVID-19 - epidemiology
10COVID-19 - prevention & control
11Decision making
12Diagnosis
13Disease transmission
14Elective surgery
15Endoscopy
16Female
17Health aspects
18Histopathology
19Human health and pathology
20Humans
21Intestine
22Life Sciences
23Male
24Medical research
25Medicin och hälsovetenskap
26Medicine, Experimental
27Middle Aged
28Neoplasms - classification
29Neoplasms - epidemiology
30Neoplasms - surgery
31Outcome Assessment, Health Care
32Pandemics
33Patients
34Proportional Hazards Models
35Prospective Studies
36Public health
37Regression analysis
38Sarcoma
39SARS-CoV-2
40Sensitivity analysis
41Severe acute respiratory syndrome coronavirus 2
42Surgery
43Time-to-Treatment
44Tumors
45Withholding Treatment
46World health
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creator
0Minaya-Bravo, Ana
1Evans, Jonathan P
2Wilkin, Richard JW
3Smart, Neil J
4Shu, Sebastian
5Valenzuela, JI
6Apas Perez de Nucci, A
7Wong, E
8Pockney, P
9Waldron, A
10Burtscher, J
11Phillips, E
12Campbell, L
13Dare, A
14Osman, F
15Vargas Añazco, C
16Puentes, LO
17Calderon Quiroz, PH
18Iversen, LH
19El Kassas, M
20Salem, H
21Atta, R
22Saifeldin, H
23Martin, L
24Pruvot, FR
25Felli, E
26Seeliger, B
27Cathala, N
28Levy-Zauberman, Y
29Hölzle, F
30Klimopoulos, S
31Kalfountzos, C
32Syllaios, A
33Tsolakidis, D
34Poonia, DR
35Silodia, A
36Najar, FA
37Owens, P
38Cullinane, C
39Fagan, J
40O'Malley, S
41Ferrari, F
42Tornese, S
43Sorbi, F
44Podda, M
45Fares Bucci, A
46Biglia, N
47Montelatici, M
48Peluso, C
49Consorti, G
50Hashimoto, D
51Oguma, J
52Alawami, A
53Thanapal, MR
54Egbuchulem, IK
55Siddiqui, T
56Akbar, A
57I. A. Alzeerelhouseini, H
58Dubienska, K
59Chloupek, A
60Teixeira, M
61De Oliveira López, AL
62Manso, MI
63Soares, A
64Silveira Nunes, I
65Litvin, A
66Semina, E
67Nassif, M
68Othman, E
69Pavlov, M
70Kajmakovic, B
71Goran, M
72Jevric, M
73Savkovic, N
74Ponce, S
75Peña Soria, MJ
76Romero de Diego, A
77Ballester, E
78Prieto Calvo, M
79Pamias, J
80Kara, H
81Gönüllü, E
82Manku, B
83Chowdhry, MF
84Henry, A
85Kittur, M
86Nunns, D
87Pissanou, T
88Abd Kahar, NN
89Beasley, N
90Fuwa, O
91McIlmunn, C
92Laurente, R
93Chung, E
94Hagger, R
95Webber, L
96Kalavrezos, N
97Agarwal, K
98Kazaure, H
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titleEffect of COVID-19 pandemic lockdowns on planned cancer surgery for 15 tumour types in 61 countries: an international, prospective, cohort study
authorMinaya-Bravo, Ana ; Evans, Jonathan P ; Wilkin, Richard JW ; Smart, Neil J ; Shu, Sebastian ; Valenzuela, JI ; Apas Perez de Nucci, A ; Wong, E ; Pockney, P ; Waldron, A ; Burtscher, J ; Phillips, E ; Campbell, L ; Dare, A ; Osman, F ; Vargas Añazco, C ; Puentes, LO ; Calderon Quiroz, PH ; Iversen, LH ; El Kassas, M ; Salem, H ; Atta, R ; Saifeldin, H ; Martin, L ; Pruvot, FR ; Felli, E ; Seeliger, B ; Cathala, N ; Levy-Zauberman, Y ; Hölzle, F ; Klimopoulos, S ; Kalfountzos, C ; Syllaios, A ; Tsolakidis, D ; Poonia, DR ; Silodia, A ; Najar, FA ; Owens, P ; Cullinane, C ; Fagan, J ; O'Malley, S ; Ferrari, F ; Tornese, S ; Sorbi, F ; Podda, M ; Fares Bucci, A ; Biglia, N ; Montelatici, M ; Peluso, C ; Consorti, G ; Hashimoto, D ; Oguma, J ; Alawami, A ; Thanapal, MR ; Egbuchulem, IK ; Siddiqui, T ; Akbar, A ; I. A. Alzeerelhouseini, H ; Dubienska, K ; Chloupek, A ; Teixeira, M ; De Oliveira López, AL ; Manso, MI ; Soares, A ; Silveira Nunes, I ; Litvin, A ; Semina, E ; Nassif, M ; Othman, E ; Pavlov, M ; Kajmakovic, B ; Goran, M ; Jevric, M ; Savkovic, N ; Ponce, S ; Peña Soria, MJ ; Romero de Diego, A ; Ballester, E ; Prieto Calvo, M ; Pamias, J ; Kara, H ; Gönüllü, E ; Manku, B ; Chowdhry, MF ; Henry, A ; Kittur, M ; Nunns, D ; Pissanou, T ; Abd Kahar, NN ; Beasley, N ; Fuwa, O ; McIlmunn, C ; Laurente, R ; Chung, E ; Hagger, R ; Webber, L ; Kalavrezos, N ; Agarwal, K ; Kazaure, H ; Najarian, M
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0Adult
1Aged
2Aged, 80 and over
3Analysis
4Cancer
5Cancer surgery
6Communicable Disease Control - legislation & jurisprudence
7Coronaviruses
8COVID-19
9COVID-19 - epidemiology
10COVID-19 - prevention & control
11Decision making
12Diagnosis
13Disease transmission
14Elective surgery
15Endoscopy
16Female
17Health aspects
18Histopathology
19Human health and pathology
20Humans
21Intestine
22Life Sciences
23Male
24Medical research
25Medicin och hälsovetenskap
26Medicine, Experimental
27Middle Aged
28Neoplasms - classification
29Neoplasms - epidemiology
30Neoplasms - surgery
31Outcome Assessment, Health Care
32Pandemics
33Patients
34Proportional Hazards Models
35Prospective Studies
36Public health
37Regression analysis
38Sarcoma
39SARS-CoV-2
40Sensitivity analysis
41Severe acute respiratory syndrome coronavirus 2
42Surgery
43Time-to-Treatment
44Tumors
45Withholding Treatment
46World health
toplevelpeer_reviewed
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0Minaya-Bravo, Ana
1Evans, Jonathan P
2Wilkin, Richard JW
3Smart, Neil J
4Shu, Sebastian
5Valenzuela, JI
6Apas Perez de Nucci, A
7Wong, E
8Pockney, P
9Waldron, A
10Burtscher, J
11Phillips, E
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15Vargas Añazco, C
16Puentes, LO
17Calderon Quiroz, PH
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19El Kassas, M
20Salem, H
21Atta, R
22Saifeldin, H
23Martin, L
24Pruvot, FR
25Felli, E
26Seeliger, B
27Cathala, N
28Levy-Zauberman, Y
29Hölzle, F
30Klimopoulos, S
31Kalfountzos, C
32Syllaios, A
33Tsolakidis, D
34Poonia, DR
35Silodia, A
36Najar, FA
37Owens, P
38Cullinane, C
39Fagan, J
40O'Malley, S
41Ferrari, F
42Tornese, S
43Sorbi, F
44Podda, M
45Fares Bucci, A
46Biglia, N
47Montelatici, M
48Peluso, C
49Consorti, G
50Hashimoto, D
51Oguma, J
52Alawami, A
53Thanapal, MR
54Egbuchulem, IK
55Siddiqui, T
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61De Oliveira López, AL
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63Soares, A
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65Litvin, A
66Semina, E
67Nassif, M
68Othman, E
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70Kajmakovic, B
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75Peña Soria, MJ
76Romero de Diego, A
77Ballester, E
78Prieto Calvo, M
79Pamias, J
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84Henry, A
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101Association of Surgeons in Training
102Global Initiative for Children's Surgery
103Transatlantic Australasian Retroperitoneal Sarcoma Working Group
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105Irish Surgical Research Collaborative
106Italian Society of Surgical Oncology
107ItSURG
108GlobalPaedSurg
109PTSurg
110Italian Society of Colorectal Surgery
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jtitleThe lancet oncology
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0Minaya-Bravo, Ana
1Evans, Jonathan P
2Wilkin, Richard JW
3Smart, Neil J
4Shu, Sebastian
5Valenzuela, JI
6Apas Perez de Nucci, A
7Wong, E
8Pockney, P
9Waldron, A
10Burtscher, J
11Phillips, E
12Campbell, L
13Dare, A
14Osman, F
15Vargas Añazco, C
16Puentes, LO
17Calderon Quiroz, PH
18Iversen, LH
19El Kassas, M
20Salem, H
21Atta, R
22Saifeldin, H
23Martin, L
24Pruvot, FR
25Felli, E
26Seeliger, B
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28Levy-Zauberman, Y
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31Kalfountzos, C
32Syllaios, A
33Tsolakidis, D
34Poonia, DR
35Silodia, A
36Najar, FA
37Owens, P
38Cullinane, C
39Fagan, J
40O'Malley, S
41Ferrari, F
42Tornese, S
43Sorbi, F
44Podda, M
45Fares Bucci, A
46Biglia, N
47Montelatici, M
48Peluso, C
49Consorti, G
50Hashimoto, D
51Oguma, J
52Alawami, A
53Thanapal, MR
54Egbuchulem, IK
55Siddiqui, T
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57I. A. Alzeerelhouseini, H
58Dubienska, K
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61De Oliveira López, AL
62Manso, MI
63Soares, A
64Silveira Nunes, I
65Litvin, A
66Semina, E
67Nassif, M
68Othman, E
69Pavlov, M
70Kajmakovic, B
71Goran, M
72Jevric, M
73Savkovic, N
74Ponce, S
75Peña Soria, MJ
76Romero de Diego, A
77Ballester, E
78Prieto Calvo, M
79Pamias, J
80Kara, H
81Gönüllü, E
82Manku, B
83Chowdhry, MF
84Henry, A
85Kittur, M
86Nunns, D
87Pissanou, T
88Abd Kahar, NN
89Beasley, N
90Fuwa, O
91McIlmunn, C
92Laurente, R
93Chung, E
94Hagger, R
95Webber, L
96Kalavrezos, N
97Agarwal, K
98Kazaure, H
99Najarian, M
aucorp
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1Association of Surgeons in Training
2Global Initiative for Children's Surgery
3Transatlantic Australasian Retroperitoneal Sarcoma Working Group
4COVIDSurg Collaborative
5Irish Surgical Research Collaborative
6Italian Society of Surgical Oncology
7ItSURG
8GlobalPaedSurg
9PTSurg
10Italian Society of Colorectal Surgery
11GlobalSurg
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atitleEffect of COVID-19 pandemic lockdowns on planned cancer surgery for 15 tumour types in 61 countries: an international, prospective, cohort study
jtitleThe lancet oncology
addtitleLancet Oncol
date2021-11
risdate2021
volume22
issue11
spage1507
epage1517
pages1507-1517
issn
01470-2045
11474-5488
eissn1474-5488
notesPMCID: PMC8492020
abstractSurgery 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. 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. 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. 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 protected elective surgical pathways and long-term investment in surge capacity for acute care during public health emergencies to protect elective staff and services. National Institute for Health Research Global Health Research Unit, Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, Medtronic, Sarcoma UK, The Urology Foundation, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research.
copEngland
pubElsevier Ltd
pmid34624250
doi10.1016/S1470-2045(21)00493-9
oafree_for_read