Effect of COVID-19 pandemic lockdowns on planned cancer surgery for 15 tumour types in 61 countries: an international, prospective, cohort study
Por:
Glasbey, JC, Ademuyiwa, A, Adisa, A, AlAmeer, E, Bravo, AM, Costas-Chavarri, A, Harrison, E, Gomes, GMA, Mann, H, McLean, K, Modolo, M, Morton, D, Ramos-De la Medina, A, Roslani, AC, Seenivasagam, RK, Simoes, JFF, Smart, N, Sullivan, R, Taylor, EH, Nepogodiev, D, Bhangu, AA, Siaw-Acheampong, K, Bywater, E, Chaudhry, D, Dawson, BE, Gujjuri, RR, Heritage, E, Jones, CS, Khatri, C, Khaw, RA, Keatley, JM, Knight, A, Lawday, S, Li, E, Mann, HS, Marson, EJ, McLean, KA, Mckay, SC, Mills, EC, Pellino, G, Picciochi, M, Tiwari, A, Trout, IM, Venn, ML, WWilkin, RJ, Smart, NJ, Evans, JP, Di Saverio, S, Vallance, A, Vimalchandran, D, Kamarajah, SK, Evans, RPT, Mckay, S, Isaac, J, Edwards, J, Coonar, AS, Marchbank, A, Layton, GR, Patel, A, Brunelli, A, Ford, S, Gronchi, A, Almond, M, Tirotta, F, Dumitra, S, Price, SJ, Fountain, DM, Hutchinson, P, Marcus, HJ, Piper, RJ, Lippa, L, Servadei, F, Esene, I, Freyschlag, C, Neville, I, Rosseau, G, Schaller, K, Demetriades, AK, Robertson, F, Alamri, A, Schache, AG, Winter, SC, Ho, M, Nankivell, P, Biel, JR, Batstone, M, Ganly, I, Wilkins, A, Singh, JK, Thekinkattil, D, Fotopoulou, C, Leung, EYL, Khan, T, Chiva, L, Sehouli, J, Fagotti, A, Cohen, P, Gutelkin, M, Ghebre, R, Konney, T, Pareja, R, Bristow, R, Dowdy, S, Shylasree, TS, Ng, J, Fujiwara, K, Lamb, B, Narahari, K, McNeill, A, Colquhoun, A, McGrath, JS, Bromage, S, Barod, R, Kasivisvanathan, V, Klatte, T, Abbott, TEF, Abukhalaf, S, Adamina, M, Ademuyiwa, AO, Agarwal, A, Akkulak, M, Alameer, E, Alderson, D, Alakaloko, F, Albertsmeier, M, Alser, O, Alshaar, M, Alshryda, S, Arnaud, AP, Augestad, KM, Ayasra, F, Azevedo, J, Bankhead-Kendall, BK, Barlow, E, Beard, D, Benson, RA, Blanco-Colino, R, Brar, A, Breen, KA, Bretherton, C, Buarque, IL, Burke, J, Caruana, EJ, Chaar, M, Chakrabortee, S, Christensen, P, Cox, D, Cukier, M, Cunha, MF, Davidson, GH, Desai, A, Edwards, JG, Drake, TM, Elhadi, M, Emile, S, Farik, S, Fiore, M, Fitzgerald, JE, Garmanova, T, Gallo, G, Ghosh, D, Grecinos, G, Griffiths, EA, Gruendl, M, Halkias, C, Harrison, EM, Hisham, I, Hutchinson, PJ, Hwang, S, Isik, A, Jenkinson, MD, Jonker, P, Kaafarani, HMA, Keller, D, Kolias, A, Kruijff, S, Lawani, I, Lederhuber, H, Leventoglu, S, Litvin, A, Loehrer, A, Loffler, MW, Lorena, MA, Modolo, MM, Major, P, Martin, J, Mashbari, HN, Mazingi, D, Metallidis, S, Minaya-Bravo, A, Mohan, HM, Moore, R, Moszkowicz, D, Moug, S, Ng-Kamstra, JS, Maimbo, M, Negoi, I, Niquen, M, Ntirenganya, F, Olivos, M, Oussama, K, Outani, O, Parreno-Sacdalanm, MD, Pata, F, Rivera, CJP, Pinkney, TD, van der Plas, W, Pockney, P, Qureshi, A, Radenkovic, D, Richards, T, Roberts, K, Roslani, AC, Rutegard, M, Segura-Sampedro, JJ, Santos, I, Satoi, S, Sayyed, R, Schache, A, Schnitzbauer, AA, Seyi-Olajide, JO, Sharma, N, Shaw, CA, Shaw, R, Shu, S, Soreide, K, Spinelli, A, Stewart, GD, Sund, M, Sundar, S, Tabiri, S, Townend, P, Tsoulfas, G, van Ramshorst, GH, Vidya, R, Warren, OJ, Wedderburn, D, Wright, N, Booth, L, Barker, M, Barker, N, Cooke, S, Dore, S, Horwood, N, Runigamugabo, E, Weir, CT, Dajti, I, Allemand, C, Boccalatte, LA, Figari, M, Lamm, M, Larranaga, J, Marchitelli, C, Noll, F, Odetto, D, Perrotta, M, Saadi, J, Zamora, L, Ballester, AM, Tapper, KE, Zeff, N, Valenzuela, JI, Alurralde, C, Anastasio, J, Apas, PDA, Caram, EL, Eskinazi, D, Mendoza, JP, Usandivaras, M, Badra, R, Esteban, A, Garcia, JS, Garcia, PM, Gerchunoff, JI, Lucchini, SM, Nigra, MA, Vargas, L, Hovhannisyan, T, Stepanyan, A, Vasey, CE, Watson, EGR, Ip, C, Kealey, J, Lim, CSH, Sengupta, S, Ward, S, Wong, E, Gould, T, Gourlay, R, Griffiths, B, Gananadha, S, McLaren, M, Cecire, J, Joshi, N, Salindera, S, Sutherland, A, Ahn, JH, Charlton, G, Chen, S, Gauri, N, Hayhurst, R, Jang, S, Jia, F, Mulligan, C, Yang, W, Ye, G, Zhang, H, Ballal, M, Gibson, D, Hayne, D, McMillan, H, Moss, J, Pugliese, MJ, Richards, T, Seow, YTN, Thian, A, Viswambaram, P, Vo, UG, Bennetts, J, Bright, T, Brooke-Smith, M, Fong, R, Gricks, B, Huang, L, Lam, YH, Nathan, A, Ong, BS, Ooi, E, Szpytma, M, Watson, D, Bagraith, K, Caird, S, Chan, E, Dawson, C, Ho, D, Hui, N, Izwan, S, Jeyarajan, E, Jordan, S, Liang, R, Lim, A, Nolan, GJ, Oar, A, Parker, D, Puhalla, H, Quennell, A, Rutherford, L, Sommerville, C, Townend, P, Von, PM, Wullschleger, M, Dawson, AC, Drane, A, Blatt, A, Cope, D, Egoroff, N, Fenton, M, Gani, J, Lott, N, Pockney, P, Shugg, N, Balagué C., Moral, A, Sánchez-López, A., Targarona, E, Aldawbali, M.
Publicada:
1 nov 2021
Ahead of Print:
1 nov 2021
Resumen:
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 restrictions. 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 (10middot0%) 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 0middot6% non-operation rate (26 of 4521), moderate lockdowns with a 5middot5% rate (201 of 3646; adjusted hazard ratio [HR] 0middot81, 95% CI 0middot77-0middot84; p<0middot0001), and full lockdowns with a 15middot0% rate (1775 of 11 827; HR 0middot51, 0middot50-0middot53; p<0middot0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0middot84, 95% CI 0middot80-0middot88; p<0middot001), and full lockdowns (0middot57, 0middot54-0middot60; p<0middot001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9middot1%] of 4521 in light restrictions, 317 [10middot4%] of 3646 in moderate lockdowns, 2001 [23middot8%] 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 protected elective surgical pathways and longterm investment in surge capacity for acute care during public health emergencies to protect elective staff and services.
Funding 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. Copyright (c) 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license.
Filiaciones:
Glasbey, JC:
Univ Birmingham, Inst Translat Med, NIHR Global Hlth Res Unit Global Surg, Birmingham, W Midlands, England
Bhangu, AA:
Univ Birmingham, Inst Translat Med, NIHR Global Hlth Res Unit Global Surg, Birmingham, W Midlands, England
Pockney, P:
John Hunter Hosp, Newcastle, NSW, Australia
Richards, T:
Fiona Stanley Hosp, Perth, WA, Australia
Townend, P:
Gold Coast Univ Hosp, Southport, Qld, Australia
Dajti, I:
Univ Hosp Ctr Nene Tereza, Tirana, Albania
Allemand, C:
Hosp Italiano De Buenos Aires, Buenos Aires, DF, Argentina
Boccalatte, LA:
Hosp Italiano De Buenos Aires, Buenos Aires, DF, Argentina
Figari, M:
Hosp Italiano De Buenos Aires, Buenos Aires, DF, Argentina
Lamm, M:
Hosp Italiano De Buenos Aires, Buenos Aires, DF, Argentina
Larranaga, J:
Hosp Italiano De Buenos Aires, Buenos Aires, DF, Argentina
Marchitelli, C:
Hosp Italiano De Buenos Aires, Buenos Aires, DF, Argentina
Noll, F:
Hosp Italiano De Buenos Aires, Buenos Aires, DF, Argentina
Odetto, D:
Hosp Italiano De Buenos Aires, Buenos Aires, DF, Argentina
Perrotta, M:
Hosp Italiano De Buenos Aires, Buenos Aires, DF, Argentina
Saadi, J:
Hosp Italiano De Buenos Aires, Buenos Aires, DF, Argentina
Zamora, L:
Hosp Italiano De Buenos Aires, Buenos Aires, DF, Argentina
Ballester, AM:
Hosp Univ Cem, Buenos Aires, DF, Argentina
Tapper, KE:
Hosp Univ Cem, Buenos Aires, DF, Argentina
Zeff, N:
Hosp Univ Cem, Buenos Aires, DF, Argentina
Valenzuela, JI:
Hosp Velez Sarsfield, Buenos Aires, DF, Argentina
Alurralde, C:
Sanatorio 9 De Julio Sa, San Miguel De Tucuman, Argentina
Anastasio, J:
Sanatorio 9 De Julio Sa, San Miguel De Tucuman, Argentina
Apas, PDA:
Sanatorio 9 De Julio Sa, San Miguel De Tucuman, Argentina
Caram, EL:
Sanatorio 9 De Julio Sa, San Miguel De Tucuman, Argentina
Eskinazi, D:
Sanatorio 9 De Julio Sa, San Miguel De Tucuman, Argentina
Mendoza, JP:
Sanatorio 9 De Julio Sa, San Miguel De Tucuman, Argentina
Usandivaras, M:
Sanatorio 9 De Julio Sa, San Miguel De Tucuman, Argentina
Badra, R:
Sanatorio Allende, Cordoba, Argentina
Esteban, A:
Sanatorio Allende, Cordoba, Argentina
Garcia, JS:
Sanatorio Allende, Cordoba, Argentina
Garcia, PM:
Sanatorio Allende, Cordoba, Argentina
Gerchunoff, JI:
Sanatorio Allende, Cordoba, Argentina
Lucchini, SM:
Sanatorio Allende, Cordoba, Argentina
Nigra, MA:
Sanatorio Allende, Cordoba, Argentina
Vargas, L:
Sanatorio Allende, Cordoba, Argentina
Hovhannisyan, T:
Nairi Med Ctr, Yerevan, Armenia
Stepanyan, A:
Nairi Med Ctr, Yerevan, Armenia
Vasey, CE:
Ballarat Base Hosp, Ballarat, Vic, Australia
Watson, EGR:
Ballarat Base Hosp, Ballarat, Vic, Australia
Ip, C:
Box Hill Hosp, Melbourne, Vic, Australia
Kealey, J:
Box Hill Hosp, Melbourne, Vic, Australia
Lim, CSH:
Box Hill Hosp, Melbourne, Vic, Australia
Sengupta, S:
Box Hill Hosp, Melbourne, Vic, Australia
Ward, S:
Box Hill Hosp, Melbourne, Vic, Australia
Wong, E:
Box Hill Hosp, Melbourne, Vic, Australia
Gould, T:
Calvary Mater Newcastle, Newcastle, NSW, Australia
Gourlay, R:
Calvary Mater Newcastle, Newcastle, NSW, Australia
Griffiths, B:
Calvary Mater Newcastle, Newcastle, NSW, Australia
Gananadha, S:
Canberra Hosp, Canberra, ACT, Australia
McLaren, M:
Canberra Hosp, Canberra, ACT, Australia
Cecire, J:
Coffs Harbour Hlth Campus, Coffs Harbour, NSW, Australia
Joshi, N:
Coffs Harbour Hlth Campus, Coffs Harbour, NSW, Australia
Salindera, S:
Coffs Harbour Hlth Campus, Coffs Harbour, NSW, Australia
Sutherland, A:
Coffs Harbour Hlth Campus, Coffs Harbour, NSW, Australia
Ahn, JH:
Concord Repatriat Gen Hosp, Sydney, NSW, Australia
Charlton, G:
Concord Repatriat Gen Hosp, Sydney, NSW, Australia
Chen, S:
Concord Repatriat Gen Hosp, Sydney, NSW, Australia
Gauri, N:
Concord Repatriat Gen Hosp, Sydney, NSW, Australia
Hayhurst, R:
Concord Repatriat Gen Hosp, Sydney, NSW, Australia
Jang, S:
Concord Repatriat Gen Hosp, Sydney, NSW, Australia
Jia, F:
Concord Repatriat Gen Hosp, Sydney, NSW, Australia
Mulligan, C:
Concord Repatriat Gen Hosp, Sydney, NSW, Australia
Yang, W:
Concord Repatriat Gen Hosp, Sydney, NSW, Australia
Ye, G:
Concord Repatriat Gen Hosp, Sydney, NSW, Australia
Zhang, H:
Concord Repatriat Gen Hosp, Sydney, NSW, Australia
Ballal, M:
Fiona Stanley Hosp, Perth, WA, Australia
Gibson, D:
Fiona Stanley Hosp, Perth, WA, Australia
Hayne, D:
Fiona Stanley Hosp, Perth, WA, Australia
McMillan, H:
Fiona Stanley Hosp, Perth, WA, Australia
Moss, J:
Fiona Stanley Hosp, Perth, WA, Australia
Pugliese, MJ:
Fiona Stanley Hosp, Perth, WA, Australia
Richards, T:
Fiona Stanley Hosp, Perth, WA, Australia
Seow, YTN:
Fiona Stanley Hosp, Perth, WA, Australia
Thian, A:
Fiona Stanley Hosp, Perth, WA, Australia
Viswambaram, P:
Fiona Stanley Hosp, Perth, WA, Australia
Vo, UG:
Fiona Stanley Hosp, Perth, WA, Australia
Bennetts, J:
Flinders Med Ctr, Adelaide, SA, Australia
Bright, T:
Flinders Med Ctr, Adelaide, SA, Australia
Brooke-Smith, M:
Flinders Med Ctr, Adelaide, SA, Australia
Fong, R:
Flinders Med Ctr, Adelaide, SA, Australia
Gricks, B:
Flinders Med Ctr, Adelaide, SA, Australia
Huang, L:
Flinders Med Ctr, Adelaide, SA, Australia
Lam, YH:
Flinders Med Ctr, Adelaide, SA, Australia
Nathan, A:
Flinders Med Ctr, Adelaide, SA, Australia
Ong, BS:
Flinders Med Ctr, Adelaide, SA, Australia
Ooi, E:
Flinders Med Ctr, Adelaide, SA, Australia
Szpytma, M:
Flinders Med Ctr, Adelaide, SA, Australia
Watson, D:
Flinders Med Ctr, Adelaide, SA, Australia
Bagraith, K:
Gold Coast Univ Hosp, Southport, Qld, Australia
Caird, S:
Gold Coast Univ Hosp, Southport, Qld, Australia
Chan, E:
Gold Coast Univ Hosp, Southport, Qld, Australia
Dawson, C:
Gold Coast Univ Hosp, Southport, Qld, Australia
Ho, D:
Gold Coast Univ Hosp, Southport, Qld, Australia
Hui, N:
Gold Coast Univ Hosp, Southport, Qld, Australia
Izwan, S:
Gold Coast Univ Hosp, Southport, Qld, Australia
Jeyarajan, E:
Gold Coast Univ Hosp, Southport, Qld, Australia
Jordan, S:
Gold Coast Univ Hosp, Southport, Qld, Australia
Liang, R:
Gold Coast Univ Hosp, Southport, Qld, Australia
Lim, A:
Gold Coast Univ Hosp, Southport, Qld, Australia
Nolan, GJ:
Gold Coast Univ Hosp, Southport, Qld, Australia
Oar, A:
Gold Coast Univ Hosp, Southport, Qld, Australia
Parker, D:
Gold Coast Univ Hosp, Southport, Qld, Australia
Puhalla, H:
Gold Coast Univ Hosp, Southport, Qld, Australia
Quennell, A:
Gold Coast Univ Hosp, Southport, Qld, Australia
Rutherford, L:
Gold Coast Univ Hosp, Southport, Qld, Australia
Sommerville, C:
Gold Coast Univ Hosp, Southport, Qld, Australia
Townend, P:
Gold Coast Univ Hosp, Southport, Qld, Australia
Von, PM:
Gold Coast Univ Hosp, Southport, Qld, Australia
Wullschleger, M:
Gold Coast Univ Hosp, Southport, Qld, Australia
Dawson, AC:
Gosford Hosp, Gosford, Australia
Drane, A:
Gosford Hosp, Gosford, Australia
Blatt, A:
John Hunter Hosp, Newcastle, NSW, Australia
Cope, D:
John Hunter Hosp, Newcastle, NSW, Australia
Egoroff, N:
John Hunter Hosp, Newcastle, NSW, Australia
Fenton, M:
John Hunter Hosp, Newcastle, NSW, Australia
Gani, J:
John Hunter Hosp, Newcastle, NSW, Australia
Lott, N:
John Hunter Hosp, Newcastle, NSW, Australia
Pockney, P:
John Hunter Hosp, Newcastle, NSW, Australia
Shugg, N:
John Hunter Hosp, Newcastle, NSW, Australia
Balagué C.:
Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
Moral, A:
Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
Sánchez-López, A.:
Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
Targarona, E:
Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
Aldawbali, M.:
Royal Hospital
Green Published, Green Submitted, hybrid, Green Accepted
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