Research News: New global study shows ‘collateral impact’ of COVID-19

By Crystal Mackay, MA'05

One in seven cancer patients around the world have missed out on surgery during COVID-19 lockdowns, a new study from COVIDSurg Collaborative has revealed. Planned cancer surgery was affected by lockdowns regardless of the local COVID-19 rates at that time, with patients in lower-income countries at highest risk of missing their surgery.

“Never before have we experienced a global surgery shutdown as that precipitated by the COVID-19 pandemic,” said Janet Martin, a Canadian principal investigator for the COVIDSurg Collaborative study, and associate professor at Western’s Schulich School of Medicine & Dentistry.

“The implication for people with cancer is significant, and the full impact is not yet known. It is only a matter of time before elective surgery becomes urgent,” said Martin.

Led by researchers at the University of Birmingham, almost 5,000 surgeons and anesthetists from around the world analyzed data from the 15 most common solid cancer types. The research covered 20,000 patients across 466 hospitals in 61 countries. The team’s findings were published in The Lancet Oncology.

Lockdowns have been essential in protecting the public from spreading infection, but they have also had significant impact on care for other patients and health conditions.

The researchers compared cancellations and delays before cancer surgery during lockdowns to those during times with light restrictions only. During full lockdowns, one in seven patients (15 per cent) did not receive their planned operation after a median of 5.3 months from diagnosis – all with a COVID-19 related reason for non-operation. However, during light restriction periods, the non-operation rate was very low (0.6 per cent).

Patients awaiting surgery for more than six weeks during full lockdown were significantly less likely to undergo their planned cancer surgery. Frail patients, those with advanced cancer, and those waiting surgery in lower-middle income countries were all less likely to have the cancer operation they urgently needed.

Martin and the global team emphasized the need for action. “Caring for complications of COVID-19 competes with the same set of resources as surgery. Surgical systems in Canada and around the globe need to urgently coordinate plans, prioritize resources, and implement strategies to reverse the ongoing pandemic effect on cancer surgery.”

She stressed that for community members, the most important action is to be vaccinated and to respect public health measures to reduce community spread. “This reduces the need for COVID-19 hospitalizations that have led to surgical shutdowns. These actions will allow our surgical systems to recover and address the backlogs sooner,” Martin said.

The research has revealed the “collateral impact” of pandemic lockdowns on patients awaiting cancer surgery, said co-lead author James Glasbey, from the University of Birmingham. “Whilst lockdowns are critical to saving lives and reducing the spread of the virus, ensuring capacity for safe elective cancer surgery should be part of every country’s plan to ensure continued health across the whole population.”

The team believes this data can help inform governments when making decisions about whether to prolong or reduce restrictions.