The Impact of the COVID-19 Pandemic on Time to Treatment in Surgical Oncology: A National Registry Study in The Netherlands

• Published in: Cancers Vol. 16; no. 9; p. 1738
• Main Authors: van Vuren, Roos M G, Janssen, Yester F, Hogenbirk, Rianne N M, de Graaff, Michelle R, van den Hoek, Rinske, Kruijff, Schelto, Heineman, David J, van der Plas, Willemijn Y, Wouters, Michel W J M
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 01.05.2024
• Subjects: Audits; Cancer; Care and treatment; Colorectal cancer; Colorectal carcinoma; Comorbidity; Comparative analysis; COVID-19; Development and progression; Health aspects; Health care; Hospitals; Lung cancer; Lung carcinoma; Malignancy; Medical diagnosis; Medicin och hälsovetenskap; Metastasis; Oncology; Oncology, Experimental; Pandemics; Patients; Surgery; Netherlands; oncological surgery; time to treatment; COVID-19 pandemic
• ISSN: 2072-6694; 2072-6694
• DOI: 10.3390/cancers16091738

To avoid delay in oncological treatment, a 6-weeks norm for time to treatment has been agreed on in The Netherlands. However, the impact of the COVID-19 pandemic on health systems resulted in reduced capacity for regular surgical care. In this study, we investigated the impact of the COVID-19 pandemic on time to treatment in surgical oncology in The Netherlands. A population-based analysis of data derived from five surgical audits, including patients who underwent surgery for lung cancer, colorectal cancer, upper gastro-intestinal, and hepato-pancreato-biliary (HPB) malignancies, was performed. The COVID-19 cohort of 2020 was compared to the historic cohorts of 2018 and 2019. Primary endpoints were time to treatment initiation and the proportion of patients whose treatment started within 6 weeks. The secondary objective was to evaluate the differences in characteristics and tumour stage distribution between patients treated before and during the COVID-19 pandemic. A total of 14,567 surgical cancer patients were included in this study, of these 3292 treatments were started during the COVID-19 pandemic. The median time to treatment decreased during the pandemic (26 vs. 27 days, < 0.001) and the proportion of patients whose treatment started within 6 weeks increased (76% vs. 73%, < 0.001). In a multivariate logistic regression analysis, adjusting for patient characteristics, no significant difference in post-operative outcomes between patients who started treatment before or after 6 weeks was found. Overall, the number of procedures performed per week decreased by 8.1% during the pandemic. This reduction was most profound for patients with stage I lung carcinoma and colorectal carcinoma. There were fewer patients with pulmonary comorbidities in the pandemic cohort (11% vs. 13%, = 0.003). Despite pressure on the capacity of the healthcare system during the COVID-19 pandemic, a larger proportion of surgical oncological patients started treatment within six weeks, possibly due to prioritisation of cancer care and reductions in elective procedures. However, during the pandemic, a decrease in the number of surgical oncological procedures performed in The Netherlands was observed, especially for patients with stage I disease.