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Effect of COVID-19 pandemic lockdowns on planned cancer surgery for 15 tumour types in 61 countries: an international, prospective, cohort study
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 PIIS1470204521004939.pdf | Published version | 1.79 MB | Adobe PDF | View/Open |
| Title: | Effect of COVID-19 pandemic lockdowns on planned cancer surgery for 15 tumour types in 61 countries: an international, prospective, cohort study |
| Authors: | Glasbey, J Ademuyiwa, A Adisa, A AlAmeer, E Arnaud, AP Ayasra, F Azevedo, J Minaya-Bravo, A Costas-Chavarri, A Edwards, J Elhadi, M Fiore, M Fotopoulou, C Gallo, G Ghosh, D Griffiths, EA Harrison, E Hutchinson, P Lawani, I Lawday, S Lederhuber, H Leventoglu, S Li, E Gomes, GMA Mann, H Marson, EJ 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, AC Kottayasamy Seenivasagam, R Shaw, R Simões, JFF Smart, N Stewart, GD Sullivan, R Sundar, S Tabiri, S Taylor, EH Vidya, R Nepogodiev, D Bhangu, A Glasbey, JC McLean, K Nepogodiev, D Harrison, E Bhangu, AA Nepogodiev, D Siaw-Acheampong, K Benson, RA Bywater, E Chaudhry, D Dawson, BE Evans, JP Glasbey, JC Gujjuri, RR Heritage, E Jones, CS Kamarajah, SK Khatri, C Khaw, RA Keatley, JM Knight, A Lawday, S Li, E Mann, HS Marson, EJ McLean, KA Mckay, SC Mills, EC Pellino, G Picciochi, M Taylor, EH Tiwari, A Simoes, JFF Trout, IM Venn, ML Wilkin, RJW Bhangu, A Glasbey, JC Smart, NJ Minaya-Bravo, A Evans, JP Gallo, G Moug, S Pata, F Pockney, P Di Saverio, S Vallance, A Vimalchandran, D Griffiths, EA Kamarajah, SK Evans, RPT Townend, P Roberts, K McKay, S Isaac, J Satoi, S Edwards, J Coonar, AS Marchbank, A Caruana, EJ Layton, GR Patel, A Brunelli, A Ford, S Desai, A Gronchi, A Fiore, M Almond, M Tirotta, F Dumitra, S Kolias, A Price, SJ Fountain, DM Jenkinson, MD Hutchinson, P Marcus, HJ Piper, RJ Lippa, L Servadei, F Esene, I Freyschlag, C Neville, I Rosseau, G Schaller, K Demetriades, AK Robertson, F Alamri, A Shaw, R Schache, AG Winter, SC Ho, M Nankivell, P Rey Biel, J Batstone, M Ganly, I Vidya, R Wilkins, A Singh, JK Thekinkattil, D Sundar, S Fotopoulou, C Leung, EYL Khan, T Chiva, L Sehouli, J Fagotti, A Cohen, P Gutelkin, M Ghebre, R Konney, T Pareja, R Bristow, R Dowdy, S Shylasree, TS Kottayasamy Seenivasagam, R Ng, J Fujiwara, K Stewart, GD Lamb, B Narahari, K McNeill, A Colquhoun, A McGrath, JS Bromage, S Barod, R Kasivisvanathan, V Klatte, T Simoes, JFF Abbott, TEF Abukhalaf, S Adamina, M Ademuyiwa, AO Agarwal, A Akkulak, M Alameer, E Alderson, D Alakaloko, F Albertsmeier, M Alser, O Alshaar, M Alshryda, S Arnaud, AP Augestad, KM Ayasra, F Azevedo, J Bankhead-Kendall, BK Barlow, E Beard, D Benson, RA Blanco-Colino, R Brar, A Minaya-Bravo, A Breen, KA Bretherton, C Buarque, IL Burke, J Caruana, EJ Chaar, M Chakrabortee, S Christensen, P Cox, D Cukier, M Cunha, MF Davidson, GH Desai, A Di Saverio, S Drake, TM Edwards, JG Elhadi, M Emile, S Farik, S Fiore, M Fitzgerald, JE Ford, S Garmanova, T Gallo, G Ghosh, D Gomes, GMA Grecinos, G Griffiths, EA Gruendl, M Halkias, C Harrison, EM Hisham, I Hutchinson, PJ Hwang, S Isik, A Jenkinson, MD Jonker, P Kaafarani, HMA Keller, D Kolias, A Kruijff, S Lawani, I Lederhuber, H Leventoglu, S Litvin, A Loehrer, A Löffler, MW Lorena, MA Modolo, MM Major, P Martin, J Mashbari, HN Mazingi, D Metallidis, S Minaya-Bravo, A Mohan, HM Moore, R Moszkowicz, D Moug, S Ng-Kamstra, JS Maimbo, M Negoi, I Niquen, M Ntirenganya, F Olivos, M Oussama, K Outani, O Parreno-Sacdalanm, MD Pata, F Rivera, CJP Pinkney, TD Van der Plas, W Pockney, P Qureshi, A Radenkovic, D Ramos-De la Medina, A Richards, T Roberts, K Roslani, AC Rutegård, M Segura-Sampedro, JJ Santos, I Satoi, S Sayyed, R Schache, A Schnitzbauer, AA Seyi-Olajide, JO Sharma, N Shaw, CA Shaw, R Shu, S Soreide, K Spinelli, A Stewart, GD Sund, M Sundar, S Tabiri, S Townend, P Tsoulfas, G Van Ramshorst, GH Vidya, R Vimalachandran, D Warren, OJ Wedderburn, D Wright, N EuroSurg Booth, L Runigamugabo, E Barker, M Barker, N Cooke, S Doré, S Horwood, N Tierney Weir, C Dajti, I Allemand, C Boccalatte, LA Figari, M Lamm, M Larrañaga, J Marchitelli, C Noll, F Odetto, D Perrotta, M Saadi, J Zamora, L Ballester, AM Tapper, KE Zeff, N Valenzuela, JI Alurralde, C Anastasio, J Apas Perez de Nucci, A Caram, EL Eskinazi, D Mendoza, JP Usandivaras, M Badra, R Esteban, A García, JS García, PM Gerchunoff, JI Lucchini, SM NIgra, MA Vargas, L Hovhannisyan, T Stepanyan, A Vasey, CE Watson, EGR Ip, C Kealey, J Lim, CSH Sengupta, S Ward, S Wong, E Gould, T Gourlay, R Griffiths, B Gananadha, S McLaren, M Cecire, J Joshi, N Salindera, S Sutherland, A Ahn, JH Charlton, G Chen, S Gauri, N Hayhurst, R Jang, S Jia, F Mulligan, C Yang, W Ye, G Zhang, H Ballal, M Gibson, D Hayne, D McMillan, H Moss, J Pugliese, MJ Richards, T Seow, YTN Thian, A Viswambaram, P Vo, UG Bennetts, J Bright, T Brooke-Smith, M Fong, R Gricks, B Huang, L Lam, YH Nathan, A Ong, BS Ooi, E Szpytma, M Watson, D Bagraith, K Caird, S Chan, E Dawson, C Ho, D Hui, N Izwan, S Jeyarajan, E Jordan, S Liang, R Lim, A Nolan, GJ Oar, A Parker, D Puhalla, H Quennell, A Rutherford, L Sommerville, C Townend, P Von Papen, M Wullschleger, M Dawson, AC Drane, A Blatt, A Cope, D Egoroff, N Fenton, M Gani, J Lott, N Pockney, P Shugg, N Elliott, M Phung, D Phan, D Townend, D Bong, C Gundara, J Frankel, A Bowman, S Guerra, GR Gerns, N McGeorge, S Riddell, A Roberts, M Rukin, N Bolt, J Buddingh, K Dudi-Venkata, NN Jog, S Kroon, HM Sammour, T Smith, R Stranz, C Batstone, M Lah, K McGahan, W Mitchell, D Morton, A Pearce, A Roberts, M Sheahan, G Swinson, B Waldron, A Walker, P Alam, N Banting, S Chong, L Choong, P Clatworthy, S Foley, D Fox, A Hii, MW Knowles, B Mack, J Read, M Rowcroft, A Ward, S Wright, G Dawson, AC Drane, A Lun, EWY Lanner, M Burtscher, J Trivik-Barrientos, F Königsrainer, I Bauer, M Freyschlag, C Kafka, M Messner, F Öfner, D Tsibulak, I Holawe, S Zimmermann, M Emmanuel, K Grechenig, M Gruber, R Harald, M Öhlberger, L Presl, J Wimmer, A Namazov, I Samadov, E Barker, D Boyce, R Corbin, S Doyle, A Eastmond, A Gill, R Haynes, A Millar, S O'Shea, M Padmore, G Paquette, N Phillips, E St. John, S Walkes, K Abeloos, J De Backer, T De Ceulaer, J Dick, C Diez-Fraile, A Lamoral, P Spaas, C Ceelen, W Pattyn, P Van de putte, D Van Nieuwenhove, Y Van Ramshorst, G Willaert, W Bazzett-Matabele, L Chiyapo, SP Ramogola-Masire, D Ramontshonyana, G Seiphetlheng, A Vuylsteke, P Abdallah, EA Aguiar Júnior, S Baiocchi, G Carvalho, GB Coimbra, FJF Kowalski, LP Makdissi, F Marques, N Marques, T Soares Dos Santos, S Tirapelli Gonçalves, B Vartanian, JG Dos Reis, R Camara, P De Lima, RK Della Giustina, E Hoffmann, PV Gatti, A Nardi, C Oliva, R Nacif, L Carvalho Ferro, C Gomes Mendonça Ataíde, G Lima Buarque, I Lira dos Santos Leite, A Pol-Fachin, L Santos Bezerra, T Maylson Ramos da Silva, A Windson de Araújo Silvestre, D Vieira Barros, A Campbell, L De Cicco, R Cecconello, I Gregorio, P Pontual Lima, L Ribeiro Junior, U Takeda, FR Terra, RM Faccini Teixeira, M Kowalski, LP Kulcsar, MAV Matos, LL Nunes, KS Laporte, G Salem, M Barakat Awada, J Ijichi, TR Kim, NJ Marreiro, A Muller, B Nunes, R Bodanese, B Eidt, ER Isoton, JC Lemos Vieira da Cunha, M Regina de Sampaio, L Vendrame, C Zeni, M Zortéa, JA Zortéa, MR Sokolov, M Kidane, B Srinathan, S Munro, A Helyer, L McKeen, D Boutros, M Caminsky, NG Ghitulescu, G Jamjoum, G Moon, J Pelletier, J Vanounou, T Wong, S Cheng, D MacNeil, SD Martin, J Boutros, M Dumitra, S Kouyoumdjian, A Schmid, S Spicer, J Agarwal, A Brar, A Dada, J Dare, A Hameed, U Osman, F Johnston, B Russell, C Groot, G Persad, A Pham, H Wood, M Brar, A Ko, M Rajendran, L Boutros, M Demyttenaere, S Garfinkle, R Brown, C Karimuddin, A Lee, N Liu, J Madani Kia, T Phang, PT Raval, M Tom, K Abou-Khalil, J Martel, A Nessim, C Stevenson, J Al Riyami, S Bali, K Bigam, D Dajani, K Dell, A Modolo, MM Ramirez Nieto, P Sepulveda, R Molero, A Bolbaran, A Ruiz, I Heredia, F Bellolio, F Besser, N Grasset, E Guaman, JO Inzunza, M Irarrázaval, MJ Jarry, C Quintana Martinic, M Riquoir Altamirano, C Romero Manqui, CA Ruiz Esquide, M Vargas Añazco, C Almeciga, A Fletcher, A Merchan, A Merchan, A Quijano, T Sanabria, D Arias-Amézquita, F Cétares, C Cortes Murgueitio, N Gomez-Mayorga, JL Herrera-Almario, G Rodriguez, J Sanabria, D Iglesias, P Puentes, LO Calvache, JA Orozco-Chamorro, CM Rojas, DA Sánchez-Gómez, A Abadia, M Acosta, J Almeciga, A Angel Aristizabal, J Bonilla, A Caicedo, L Calderon Quiroz, PH Cervera Bonilla, S Diaz, S Facundo, H Garcia Mora, M Guevara, O Guzman, L Herrera Mora, DR Jimenez Ramirez, LJ Lehmann, C Manrique, E Mariño, I Medina, M Pinilla Morales, RE Puerto, A Puerto Horta, J Quintero, M Rey Ferro, M Rodriguez, J Saénz, A Santana, D Serrano, W Suescun, O Trujillo Sanchez, LM Velasquez Cuasquen, BG Mendoza Quevedo, J Bacic, G Karlovic, D Kršul, D Zelic, M Luksic, I Mamic, M Bacic, I Bakmaz, B Coza, I Dijan, E Katusic, Z Mihanovic, J Morovic, D Rakvin, I Almezghwi, H Arslan, K Besim, H Özant, A Özçay, N Frantzeskou, K Gouvas, N Kokkinos, G Papatheodorou, P Pozotou, I Stavrinidou, O Yiallourou, A Martinek, L Skrovina, M Straka, M Szubota, I Peteja, M Žatecký, J Javurkova, V Klat, J Antony, S Avlund, T Berg, KD Borre, M Christensen, P Elkjær, MC Ernst, A Fensman, SK Haldrup, M Harbjerg, JL Iversen, LH Jensen, PT Jeppesen, TD Kjaer, DW Kristensen, H Lund, N Maigaard Axelsen, S Mekhael, M Mikic, N Ostenfeld, EB Ebbehøj, AL Krarup, P Schlesinger, N Smith, H Batista, S Crespo, A Díaz, PJ Rivas, R Rodriguez-Abreu, J Tactuk, N El Kassas, M Omar, W Tawheed, A Talaat, M Abdelsamed, A Azzam, AY Salem, H Seleim, A Abdelmajeed, A Abdou, M Abosamak, NE AL Sayed, M Ashoush, F Atta, R Elazzazy, E Elnemr, M Elsayed Hewalla, ME Elsherbini, I Essam, E Ewedah, M Ghallab, I Hassan, E Ibrahim, M Metwalli, M Mourad, M Qatora, MS Ragab, M Sabry, A Saifeldin, H Samih, A Samir Abdelaal, A Shehata, S Shenit, K Attia, D Kamal, N Osman, N Abbas, AM Abd Elazeem, HAS Abd-Elkariem, AY Abdelkarem, MM Alaa, S Ashraf, M Ayman, A Azizeldine, MG Elkhayat, H Emad Mashhour, A Gaber, M Hamza, HM Hawal, I Hetta, HF K. Ali, A M.elghazaly, S Mohammed, MM Monib, FA Nageh, MA Saad, A Saad, MM Shahine, M Yousof, EA Youssef, A El-Deeb, M Fawzy, M Ghaly, G Ibraheem, M Eldaly, A Esmail, E ElFiky, M Nabil, A Alrahawy, M Sakr, A Soliman, H Soltan, H Amira, G Sallam, I Sherief, M Sherif, A Abdelrahman, A Aboulkassem, H Ghaly, G Hamdy, R Morsi, A Salem, H Sherif, G Abdeldayem, H Abdelkader Salama, I Balabel, M Fayed, Y Sherif, AE Elmorsi, R Emile, S Refky, B Abd-elsalam, S Badr, H Elbahnasawy, M Elzoghby, M Essa, M Gamal Badr, S Ghoneim, A Hamad, O Hamada, M Hammad, M Hawila, A Morsy, MS Salman, S Sarsik, S Bekele, K Kauppila, JH Sarjanoja, E Helminen, O Huhta, H Kauppila, JH Beyrne, C Jouffret, L Lugans, L Marie-Macron, L Chouillard, E De Simone, B Fredon, F Roux, A Bettoni, J Dakpé, S Devauchelle, B Lavagen, N Testelin, S Boucher, S Breheret, R Gueutier, A Kahn, A Kün-Darbois, J Barrabe, A Lakkis, Z Louvrier, A Manfredelli, S Mathieu, P Chebaro, A Drubay, V El amrani, M Eveno, C Lecolle, K Legault, G Martin, L Piessen, G Pruvot, FR Truant, S Zerbib, P Ballouhey, Q Barrat, B Fourcade, L Laloze, J Salle, H Taibi, A Tricard, J Usseglio, J Bergeat, D Merdrignac, A Le Roy, B Perotto, LO Scalabre, A Gornes, H Vaysse, C Vergriete, K Aimé, A Ezanno, A Malgras, B Arnaud, AP Fustec, E Lavoue, V Tesson, C Bouche, P Tzedakis, S Cotte, E Glehen, O Lifante, J Bendjemar, L Braham, H Charre, L El Arbi, N Morel-chevillet, L Police, A Villefranque, V Volpin, E D'Urso, A Felli, E Mutter, D Pessaux, P Seeliger, B Barbé, Y Bardet, J Barret, E Berry, R Boddaert, G Bonnet, S Brian, E Cathala, N Cathelineau, X Denet, C Fuks, D Gossot, D Grigoroiu, M Laforest, A Levy-Zauberman, Y Louis-Sylvestre, C Macek, P Mombet, A Moumen, A Pourcher, G Rozet, F Sanchez Salas, R Seguin-givelet, A Tribillon, E Crenn, V De Vergie, S Duchalais, E Espitalier, F Ferron, C Fragnaud, H Malard, O Regenet, N Rigaud, J Varenne, Y Waast, D Bork, U Distler, M Fritzmann, J Kirchberg, J Praetorius, C Riediger, C Weitz, J Welsch, T Wimberger, P Beyer, K Kamphues, C Lauscher, J Loch, FN Schineis, C Albertsmeier, M Angele, M Kappenberger, A Niess, H Schiergens, T Werner, J Becker, R Jonescheit, J Doerner, J Seiberth, R Pergolini, I Reim, D Herzberg, J Honarpisheh, H Strate, T Boeker, C Hakami, I Mall, J Liokatis, P Smolka, W Vassos, N Nowak, K Reinhard, T Hölzle, F Modabber, A Winnand, P Anthuber, M Shiban, E Sommer, B Sommer, F Wolf, S Howaldt, H Knitschke, M Kauffmann, P Wolfer, S Kleeff, J Lorenz, K Michalski, C Ronellenfitsch, U Schneider, R Bertolani, E Königsrainer, A Löffler, MW Quante, M Steidle, C Überrück, L Yurttas, C Betz, CS Bewarder, J Böttcher, A Burg, S Busch, C Dreimann, M Frosch, KH Gosau, M Heuer, A Izbicki, J Klatte, TO Koenig, D Moeckelmann, N Nitschke, C Perez, D Priemel, M Reiter, A Smeets, R Speth, U Stangenberg, M Thole, S Uzunoglu, FG Viezens, L Vollkommer, T Zeller, N Battista, MJ Gillen, K Hasenburg, A Krajnak, S Linz, VC Schwab, R Amo-Antwi, K Appiah-kubi, A Konney, T Tawiah, A Boatey, S Issaka, A Korsah, MA Sheriff, M Angelou, K Haidopoulos, D Rodolakis, A Antonakis, P Bramis, K Chardalias, L Contis, I Dafnios, N Dellaportas, D Fragulidis, G Gklavas, A Konstadoulakis, M Memos, N Papaconstantinou, I Polydorou, A Theodosopoulos, T Vezakis, A Antonopoulou, MI Manatakis, DK Tasis, N Arkadopoulos, N Danias, N Economopoulou, P Frountzas, M Kokoropoulos, P Larentzakis, A Michalopoulos, N Nastos, C Parasyris, S Pikoulis, E Selmani, J Sidiropoulos, T Vassiliu, P Bouchagier, K Klimopoulos, S Paspaliari, D Stylianidis, G Akrivou, D Baxevanidou, K Bouliaris, K Chatzikomnitsa, P Delinasios, G Doudakmanis, C Efthimiou, M Giaglaras, A Kalfountzos, C Kolla, C Koukoulis, G Zervas, K Zourntou, S Baloyiannis, I Diamantis, A Gkrinia, E Hajiioannou, J Korais, C Koukoura, O Perivoliotis, K Saratziotis, A Skoulakis, C Symeonidis, D Tepetes, K Tzovaras, G Zacharoulis, D Alexoudi, V Antoniades, K Astreidis, I Christidis, P Deligiannidis, D Grivas, T Ioannidis, O Kalaitsidou, I Loutzidou, L Mantevas, A Michailidou, D Nikolaidou, E Papadopoulou, S Paraskevopoulos, K Politis, S Stavroglou, A Tatsis, D Tilaveridis, I Vahtsevanos, K Venetis, G Karaitianos, I Tsirlis, T Dinas, K Margioula-Siarkou, C Petousis, S Baili, E Charalabopoulos, A Liakakos, T Schizas, D Spartalis, E Syllaios, A Zografos, C Anthoulakis, C Christou, CD Papadopoulos, V Tooulias, A Tsolakidis, D Tsoulfas, G Zouzoulas, D Athanasakis, E Chrysos, E Tsiaoussis, I Xenaki, S Xynos, E Barrios Duarte, A Lopez Muralles, I Lowey, MJ Portilla, AL Recinos, G Chan, JYK Chan, SM Chong, CCN Futaba, K Ho, MF Hon, SF Lau, RWH Mak, TWC Ng, CF Ng, CSH Ng, KKC Ng, SSM Teoh, AYB Teoh, JY Foo, CC Banky, B Suszták, N Misra, S Pareek, P Vishnoi, JR Ambre, S Balasubiramaniyan, V Chappity, P Chaudhary, I Colney, L Das, MK Imaduddin, M Jain, A Jena, SK Kar, M Mandal, S Mishra, A Mishra, SS Mishra, TS Mitra, JK Mittal, Y Muduly, DK Nayak, P Parida, PK Pradhan, P Rajan, DK Rebba, E Samal, DK Singh, A Sultania, M Agarwal, SP Agrawal, A Arora, RK Chaturvedi, J Garg, PK Gaurav, A Gupta, A Kottayasamy Seenivasagam, R Maharaj, DD Majumdar, KS Mishra, N Mittal, A Narain, TA Nirjhar, R Poonia, DR Sadhasivam, S Singh, MP Tiwari, AR Akula, AK Bandegudda, SK Bindlish, RP Chaitanya, A Chandrasekhara Rao, LM Dalakoti, P Dasu, S Giridhar, A Gorijavolu, NB Iyer, RR Jayakarthik, Y Jonathan, GT Kalla, MB Kheni, Y Kumar, CS Murtuza, SA Naidu, CCK Nalukurthi, RK Nemade, HO Nusrath, S Patnaik, SC Raju, KVVN Ramalingam, PR Rao, KV Rayani, BK Reddy Kallam, SM Reddy, SRR Saksena, AR Sebastian, JA Sharma, RM Thammineedi, SR Krishnamurthy, A Madhupriya, S Raja, A Ramakrishnan, AS Dutt, UK Ghosh, DN Grewal, S Hans, P Haque, PD Jain, R Kingsley, PA Mahajan, A Mandrelle, K Michael, V Mukherjee, P Varghese, A Varghese, SS Veetil, SK Gaikwad, P George, AJ James, SM Jesudason, MR Mittal, R Moorthy, M Riju, J Sebastian, A Sen, S Singh, S Sreekar, D Thomas, V Titus, DK Yezzaji, HS Aggarwal, M Dhamija, P Kumar, A Chisthi, MM Gejoe, G Gopakumar, D Kollengode, VV Kuttanchettiyar, KG Yadev, I Balasubramanian, A Chaturvedula, L Dharanipragada, K Kalayarasan, R Manikandan, R Penumadu, P Lakshminarayana, B Mathew, S Reddihalli, PV Shivdas, S Akhtar, N Chaturvedi, A Gupta, S Kumar, V Rajan, S Agrawal, N Ahluwalia, P Arora, A Batra-Modi, K Biswas, M Chaturvedi, A Chaturvedi, H Gautam, G Jain, M Jain, S Kumar, S Nayyar, R Singh, S Tiwari, A Bhushan Rangappa, V Kadapathri, A Kolur, T Pethkar, R Pillai, V Popli, G Sharma, J Shetty, V Subramaniam, N Williams, J Agarwal, P Agarwal, V Baghel, A Sharma, DB Silodia, A Singh, KN Yadav, SK Aziz, G Chowdri, N Mehraj, A Parray, FQ Shah, ZA Wani, RA Ahmed, Z Bali, RS Bhat, MA Laharwal, AR Mahmood, M Mir, IS Muzamil, J Najar, FA Rashid, A Rather, MH Zaieem, M Aggarwal, G Agrawal, V Ahmed, A Ahmed, R Bhaumik, J Ghosh, A Gupta, S Jain, D Jain, PV Kewlani, V Pipara, A Shakya, S Sharma, A Thambudorai, R Badwe, RA Bakshi, G Chandankhede, U Chaudhari, V Chaukar, D Chitkara, G Dash, B Deshmukh, A DeSoouza, A Gulia, A 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Foley, E Schwartz, PB Zafar, SN Hawkins, AT Maiga, A Ruzgar, NM Sion, M Ullrich, S Laufer, J Scasso, S Al-Naggar, H Al-Shehari, M Almassaudi, A Alsayadi, M Alsayadi, R Nahshal, M Shream, S AL-Ameri, S Aldawbali, M |
| Item Type: | Journal Article |
| Abstract: | 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 restriction. 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 <20), moderate lockdowns (20–60), and full lockdowns (>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 (10·0%) 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 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long-term investment in surge capacity for acute care during public health emergencies to protect elective staff and services. Funding National Institute for Health Research Global Health Research Unit, Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, Medtronic, Sarcoma UK, The Urology Foundation, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research. |
| Issue Date: | Nov-2021 |
| Date of Acceptance: | 1-Oct-2021 |
| URI: | http://hdl.handle.net/10044/1/91973 |
| DOI: | 10.1016/s1470-2045(21)00493-9 |
| ISSN: | 1470-2045 |
| Publisher: | Elsevier BV |
| Start Page: | 1507 |
| End Page: | 1517 |
| Journal / Book Title: | The Lancet Oncology |
| Volume: | 22 |
| Issue: | 11 |
| Copyright Statement: | © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. |
| Sponsor/Funder: | Imperial College Healthcare NHS Trust- BRC Funding National Institute for Health Research |
| Funder's Grant Number: | RDB01 79560 NIHR-RP-011-053 |
| Keywords: | Science & Technology Life Sciences & Biomedicine Oncology MENTAL-HEALTH IMPACT UK Adult Aged Aged, 80 and over COVID-19 Communicable Disease Control Female Humans Male Middle Aged Neoplasms Outcome Assessment, Health Care Proportional Hazards Models Prospective Studies SARS-CoV-2 Time-to-Treatment Withholding Treatment COVIDSurg Collaborative Humans Neoplasms Withholding Treatment Proportional Hazards Models Prospective Studies Communicable Disease Control Adult Aged Aged, 80 and over Middle Aged Female Male Time-to-Treatment Outcome Assessment, Health Care COVID-19 SARS-CoV-2 Oncology & Carcinogenesis 1112 Oncology and Carcinogenesis |
| Publication Status: | Published |
| Online Publication Date: | 2021-10-05 |
| Appears in Collections: | Department of Surgery and Cancer Faculty of Medicine Imperial College London COVID-19 |
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