Cancer surgery access and the COVID-19 pandemic study published

Access to cancer surgery was greatly impacted in the early days of the COVID-19 pandemic in Ontario, a new study has found. Patients who did receive cancer surgery were not sociodemographically different, suggesting access was equitable though limited.

Published today in JAMA Network Open, the study compared volumes and sociodemographic (income, race, location) characteristics of 543,741 patients who underwent cancer surgery at 112 Ontario hospitals before and during the COVID-19 outbreak (from January 2018 to June 2020)

Immediately after the pandemic was declared in March 2020, there was a 60 per cent drop in cancer surgeries.

Each week following, the number of cancer surgeries increased by 6 per cent.

From March 15 to June 30, 2020, 36,671 fewer cancer surgeries were performed in Ontario compared to the same time frame in 2019.

By June 30, the volume of cancer surgeries had not yet returned to pre-pandemic levels.

“Measures aimed at creating hospital capacity for COVID-19 led to a major disruption in surgical cancer care,” says Dr. Antoine Eskander, Sunnybrook surgeon-scientist and author on the study. “Importantly in a universal healthcare system, one’s race, income and other sociodemographic factors did not affect whether a person received cancer surgery in that early pandemic period. This suggests equally equitable access for surgical patients during the pandemic compared to before the pandemic.”

In a universal healthcare system, it is important to ensure that care is being provided equitably, he adds.

“This data suggests that during the early pandemic period, lower socioeconomic status did not lead to lower access to surgery. However, the data also highlights the backlog of surgical cases, which is concerning given there’s no clear path toward recovery. Surgical services in many parts of the province have not recovered to 100 per cent, even to this day.”

This research highlights the need for innovative models to catch up on the backlog of surgical cases and emphasizes the importance of prioritizing cases based on likelihood of a poor outcome with prolonged wait, he says.

“Future research is required to assess cancer incidence and how it was impacted by a decrease in the use of screening programs, imaging, and in-person physician visits,” Dr. Eskander says. “This may impact short-term policies as they relate to future waves of the pandemic and prioritizing the continuation of surgical services.”