Feasibility and usability of a regional hub model for colorectal cancer services during the COVID-19 pandemic

Global elective breast- and colorectal cancer surgery performance backlogs, attributable mortality and implemented health system responses during the COVID-19 pandemic: A scoping review

Globally, 28.4 million non-emergent ('elective') surgical procedures have been deferred during the COVID-19 pandemic. This study evaluated the impact of the COVID-19 pandemic on elective breast- or colorectal cancer (CRC) procedure backlogs and attributable mortality, globally. Further, we evaluated the interaction between procedure deferrals and health systems, internationally. Relevant articles from any country, published between December 2019-24 November 2022, were identified through searches of online databases (MEDLINE, EMBASE) and by examining the reference lists of retrieved articles. We organised health system-related findings thematically per the Structures-Processes-Outcomes conceptual model by Donabedian (1966). Of 337 identified articles, we included 50. Eleven (22.0%) were reviews. The majority of included studies originated from high-income countries (n = 38, 76.0%). An ecological, modelling study elucidated that global 12-week procedure cancellation rates ranged from 68.3%-73%; Europe and Central Asia accounted for the majority of cancellations (n = 8,430,348) and sub-Saharan Africa contributed the least (n = 520,459). The percentage reduction in global, institutional elective breast cancer surgery activity ranged from 5.68%-16.5%. For CRC, this ranged from 0%-70.9%. Significant evidence is presented on how insufficient pandemic preparedness necessitated procedure deferrals, internationally. We also outlined ancillary determinants of delayed surgery (e.g., patient-specific factors). The following global health system response themes are presented: Structural changes (i.e., hospital re-organisation), Process-related changes (i.e., adapted healthcare provision) and the utilisation of Outcomes (i.e., SARS-CoV-2 infection incidence among patients or healthcare personnel, postoperative pulmonary complication incidence, hospital readmission, length of hospital stay and tumour staging) as indicators of health system response efficacy. Evidence on procedure backlogs and attributable mortality was limited, partly due to insufficient, real-time surveillance of cancer outcomes, internationally. Elective surgery activity has decreased and cancer services have adapted rapidly, worldwide. Further research is needed to understand the impact of COVID-19 on cancer mortality and the efficacy of health system mitigation measures, globally.

The influence of the Covid-19 pandemic on the 90-day mortality rate after emergency surgery for colon cancer

The Covid-19 pandemic had a significant impact on the treatment of colon cancer. This was due to the redistribution of doctors and medical resources to empower the treatment of Sars-CoV-2-infected patients. Moreover, the restrictions imposed by the authorities on the general population and hospitals were other key elements that had to be taken into consideration. The surgical activity was massively reduced for both elective and emergency surgeries during the pandemic; initially, the elective ones were postponed. This study aimed to analyze the impact of the Covid-19 pandemic on the 90-day postoperative mortality rate of patients who underwent emergency surgery for colon cancer in the First General Surgery Clinic of Pius Brinzeu County Hospital Timisoara. For conducting this study, data from patients who underwent emergency surgery for colon cancer between 26.02.2020-01.10.2021 and the same period of 2016-2017 and 2018-2019 were collected and analyzed, with a p<0.05 being considered statistically significant. As a result, the 90-days postoperative mortality rate increased to 34.5% during the pandemic. A 22.55% rate was observed during 2016-2017 and an 18.4% rate in 2018-2019. In addition, during the pandemic, correlations w ere identified between the presence of 90-day postoperative mortality and severe symptomatology when presenting to the hospital, stage of the disease, and Charlson comorbidity index. All these aspects influenced the 90-days mortality rate of patients undergoing emergency surgery to treat colon cancer during the pandemic.