Lasting Impacts of the COVID-19 Pandemic on Breast Cancer Diagnosis and Treatment in the United States

The COVID-19 pandemic was an unprecedented time that placed unique challenges on the screening and treatment of breast cancer in the United States. Collaboration among medical disciplines and societies provided guidelines and strategies to mitigate the exposure of patients and medical providers to the virus and provide optimal care. We discuss the changes that the pandemic had on the multidisciplinary management of breast cancer.

COVID-19 and the forgone health benefits of elective operations

BACKGROUND AND AIM

The first SARS-CoV-2 pandemic wave in Germany involved a tradeoff between saving the lives of COVID-19 patients by providing sufficient intensive care unit (ICU) capacity and foregoing the health benefits of elective procedures. This study aims to quantify this tradeoff.

METHODS

The analysis is conducted at both the individual and population levels. The analysis calculates quality-adjusted life years (QALYs) to facilitate a comparison between the health gains from saving the lives of COVID-19 patients in the ICU and the health losses associated with postponing operative procedures. The QALYs gained from saving the lives of COVID-19 patients are calculated based on both the real-world ICU admissions and deaths averted from flattening the first wave. Scenario analysis was used to account for variation in input factors.

RESULTS

At the individual level, the resource-adjusted QALY gain of saving one COVID-19 life is predicted to be 3 to 15 times larger than the QALY loss of deferring one operation (the average multiplier is 9). The real-world QALY gain at the population level is estimated to fall within the range of the QALY loss due to delayed procedures. The modeled QALY gain by flattening the first wave is 3 to 31 times larger than the QALY loss due to delayed procedures (the average multiplier is 17).

CONCLUSION

During the first wave of the pandemic, the resource-adjusted health gain from treating one COVID-19 patient in the ICU was found to be much larger than the health loss from deferring one operation. At the population level, flattening the first wave led to a much larger health gain than the health loss from delaying operative procedures.

The impact of the coronavirus disease 2019 pandemic on elective urological procedures in Australia

Objective

To investigate the changes in elective private urological procedures in Australia during the coronavirus disease 2019 pandemic.

Methods

Data were extracted from publicly available datasets from Medicare Benefits Schedule using item numbers assigned to each commonly performed urological intervention. These procedures were divided into three groups: Oncological therapeutic, diagnostic, and non-oncological therapeutic procedures. A smoothing model, based on the historic procedure numbers from 2017 to 2019, was used to forecast monthly number of procedures performed in each category between January 2020 and June 2020. These forecasted models were compared with reported figures.

Results

A total of 108 169 procedures were performed between January 2020 and June 2020 based on the Medicare Benefits Schedule item numbers listed. There was a significant reduction (percentage change) in total procedures performed in April 2020 (−22.6%, 95% confidence interval [CI]: −28.7% to −15.4%) and May 2020 (−33.2%, 95% CI: −37.5% to −28.3%). There was a significant reduction in oncological therapeutic, non-oncological therapeutic, and diagnostic procedures performed in April 2020 and May 2020 (p<0.05). These numbers did not include procedures performed in public sector.

Conclusion

There was a significant reduction in total urological procedures (including diagnostic, oncological, and non-oncological) performed in months of April 2020 and May 2020 during time of federal restrictions. Both public and private healthcare sectors need to be supported in the upcoming months to prevent further delays in treatment and poorer clinical outcomes.

Elective shoulder surgery during the coronavirus disease 2019 pandemic in Germany: the patients' perspective

Background

The coronavirus disease 2019 (COVID-19) pandemic has impeded the treatment of elective shoulder patients all over the world. Owing to the constraints in personnel and operation theater capacities, many patients who should undergo planned surgeries could not receive medical care. In our study, we examined the status quo of elective shoulder arthroscopy during the pandemic in Germany.

Methods

Using a nonprofit database, 40 shoulder units that performed the most arthroscopic rotator cuff repairs in Germany in 2018 were identified. Following a standardized protocol, the web pages of these units were screened, and their strategy for elective procedures during the COVID-19 pandemic was analyzed. Special emphasis was put on the use of new digital technologies.

Results

At the time of the study, no unit had stopped scheduling appointments for elective shoulder patients because of the pandemic. Almost all units (97.5%) offered explicit information about COVID-19 and their strategies toward it. The possibilities of visiting patients in shoulder units varied owing to local restrictions. Two units (5%) offered digital consultations.

Conclusion

At the time of the study, elective shoulder procedures could be planned and carried out at the largest centers in Germany. Local restrictions had a great influence on the organization of the procedure and hospital stay during the COVID-19 pandemic. Digital consultations were not available in every unit.

An Analysis of Public Interest in Elective Neurosurgical Procedures During the COVID-19 Pandemic Through Online Search Engine Trends

OBJECTIVE

In the wake of the COVID-19 pandemic, the Centers for Medicare & Medicaid Services (CMS) has recommended the temporary cessation of all elective surgeries. The effects on patients' interest of elective neurosurgical procedures are currently unexplored.

METHODS

Using Google Trends, search terms of 7 different neurosurgical procedure categories (trauma, spine, tumor, movement disorder, epilepsy, endovascular, and miscellaneous) were assessed in terms of relative search volume (RSV) between January 2015 and September 2020. Analyses of search terms were performed for over the short term (February 18, 2020, to April 18, 2020), intermediate term (January 1, 2020, to May 31, 2020), and long term (January 2015 to September 2020). State-level interest during phase I reopening (April 28, 2020, to May 31, 2020) was also evaluated.

RESULTS

In the short term, RSVs of 4 categories (epilepsy, movement disorder, spine, and tumor) were significantly lower in the post-CMS announcement period. In the intermediate term, RSVs of 5 categories (miscellaneous, epilepsy, movement disorder, spine, and tumor) were significantly lower in the post-CMS announcement period. In the long term, RSVs of nearly all categories (endovascular, epilepsy, miscellaneous, movement disorder, spine, and tumor) were significantly lower in the post-CMS announcement period. Only the movement disorder procedure category had significantly higher RSV in states that reopened early.

CONCLUSIONS

With the recommendation for cessation of elective surgeries, patient interests in overall elective neurosurgical procedures have dropped significantly. With gradual reopening, there has been a resurgence in some procedure types. Google Trends has proven to be a useful tracker of patient interest and may be used by neurosurgical departments to facilitate outreach strategies.

Practices and attitudes of bariatric surgeons in Israel during the first phase of the COVID-19 pandemic

Introduction

Israel ranks very high globally in performing bariatric surgery (BS) per capita. In the first phase of the COVID-19 pandemic the bariatric surgeons’ community faced many concerns and challenges, especially in light of a decree issued by the Ministry of Health (MOH) on March 22nd, to ban all elective surgery in public hospitals. The aim of this study is to portray the practices and attitudes of Israeli bariatric surgeons in the first phase of the pandemic.

Methods

Anonymous web-based questionnaire sent to all active bariatric surgeons in Israel. Statistical analysis was performed using SAS software package.

Results

53 out of 63 (84%) active surgeons responded to the survey. 18% practice in the public sector only, 4% in the private sector only and 78% in both sectors. 76% practice BS for more than 10 years and 68% perform more than 100 procedures a year. Almost all the surgeons (98%) experienced a tremendous decrease in operations. Nevertheless, there were substantial differences by sectors. In the public sector, 86% of the surgeons ceased to operate while 14% did not comply with the government’s decree. In the public sector 69% of the surgeons were instructed by the administrators to stop operating. The majority of surgeons who continued to operate (77%) changed nothing in the indications or contra-indications for surgery. Among the surgeons who opted to refrain from operating on special sub-groups, the most frequent reasons were pulmonary disease (82%), age above 60 (64%), Ischemic heart disease (55%) and living in heavily affected communities. Roughly only half (57%) of the surgeons implemented changes in informed consent and operating room (OR) measures, contrary to guidelines and recommendations by leading professional societies. When asked about future conditions for reestablishing elective procedures, the reply frequencies were as follows: no special measures - 40%; PCR negativity - 27%; IgG positivity - 15%; waiting until the end of the pandemic- 9%.

Conclusions

We showed in this nation-wide survey that the variance between surgeons, regarding present and future reactions to the COVID-19 pandemic, is high. There were substantial differences between the private and the public sectors. Although the instructions given by the MOH for the public sector were quite clear, the compliance by surgeons and administrators was far from complete. The administrators in the public sector, but more so in the private sector were ambiguous in instructing staff, leading surgeons to a more “personal non-structured” practice in the first phase of the pandemic. These facts must be considered by regulators, administrators and surgeons when planning for reestablishing elective BS or in case a second wave of the pandemic is on its way.