Covid-19 lockdowns ‘delaying surgery on life-threatening cancers’

Lockdowns have resulted in delays to surgery for life-threatening ­cancers, with one in seven patients having to wait on average an extra five months.

Lockdowns have resulted in delays to surgery for life-threatening ­cancers, with one in seven patients having to wait on average an extra five months.

A study published in the Lancet, involving 20,000 patients from 61 countries, found that high-income countries, including Australia, had experienced severe delays because of the pandemic. Surgeons reported that lockdowns had had collateral impacts on cancer patients, with life-threatening bowel cancers, breast cancer and gynaecological cancers including ovarian and uterine cancers commonly delayed.

In Australia, elective surgery was suspended for several months last year and is currently suspended in NSW and Victoria, except for urgent Category 1 and Category 2 surgeries.

However, an Australian contributor to the Lancet study, Royal Adelaide Hospital colorectal surgeon Tarik Sammour, said even urgent surgeries had been delayed because of lockdowns and Covid-19.

“At the Royal Adelaide Hospital, we did mostly continue doing what we would regard as Category 1 surgery. But at one point, there was a not insignificant number of patients in the hospital with Covid. And so say there was a patient that was from a high-risk Covid area with a bowel cancer, and they had a minor sore throat or a cough. It’s not inconceivable those patients’ surgeries would be delayed because there was a risk they had Covid. Or some people’s surgery may not have been immediately possible because of a lack of ICU beds.

“There is no question that cancer surgery, based on my anecdotal experience, has been delayed as a result of Covid and lockdown.”

Researchers are calling for major global reorganisation during the recovery from the pandemic to provide protected elective surgical pathways and critical care beds to allow surgery to continue safely, as well as investment in “surge” capacity for future public health emergencies.

The surgeons are calling for “ring-fenced” intensive care beds for patients with conditions other than Covid to make sure urgent surgeries requiring ICU care afterwards can be performed in a timely manner, even when ICUs are full with Covid patients.

The study was published after leading cancer surgeons raised the alarm that the suspension of elective surgery in NSW and Victoria could lead to fatal outcomes even for patients requiring non-­urgent surgery.

Payal Mukherjee, the chair of the NSW state committee of the Royal Australian College of Surgeons, said the pandemic meant non-urgent cancers were harder to monitor closely and might spread or cause complications that could lead to adverse outcomes.

“There are some cancers that are not urgent. However, if they suddenly grow rapidly during the delay period, the patient’s outcome will be compromised. And that will directly influence their short-term and long-term survival,” Professor Mukherjee said.

Dr Sammour said international data had shown that for every four weeks of delay to cancer surgery, there was a measurable reduction in outcomes.