Effect of COVID-19 pandemic lockdowns on planned cancer surgery for 15 tumour types in 61 countries: an international, prospective, cohort study
In: Glasbey , J C , Ademuyiwa , A , Adisa , A , AlAmeer , E , Arnaud , A P , Ayasra , F , Azevedo , J , Bravo , A M , Costas-Chavarri , A , Edwards , J , Elhadi , M , Fiore , M , Fotopoulou , C , Gallo , G , Ghosh , D , Griffiths , E A , Harrison , E , Hutchinson , P , Lawani , I , Lawday , S , Lederhuber , H , Leventoglu , S , Li , E , Gomes , G M A , Mann , H , Marson , E J , Martin , J , Mazingi , D , McLean , K , Modolo , M , Moore , R , Morton , D , Ntirenganya , F , Pata , F , Picciochi , M , Pockney , P , Ramos-De la Medina , A , Roberts , K , Roslani , A C , Seenivasagam , R K , Shaw , R , Simoes , J F F , Smart , N , Stewart , G D , Sullivan , R , COVIDSurg Collaborative , Global Initiative for Children's Surgery , GlobalSurg , GlobalPaedSurg , ItSURG , PTSurg , SpainSurg , Italian Society of Colorectal Surgery , Association of Surgeons in Training , Irish Surgical Research Collaborative , Transatlantic Australasian Retroperitoneal Sarcoma Working Group , Italian Society of Surgical Oncology , Kuiper , S Z , Melenhorst , J , Poeze , M , Sluijpers , N R F & Vaassen , L A A 2021 , ' Effect of COVID-19 pandemic lockdowns on planned cancer surgery for 15 tumour types in 61 countries: an international, prospective, cohort study ' , Lancet oncology , vol. 22 , no. 11 , pp. 1507-1517 . https://doi.org/10.1016/S1470-2045(21)00493-9
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 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; ...