Continuity of Cancer Care: The Surgical Experience of Two Large Cancer Hubs in London and Milan

Abstract

The SARS-CoV-2 (COVID-19) pandemic is having a large effect on the management of cancer patients. This study reports on the approach and outcomes of cancer patients receiving radical surgery with curative intent between March and September 2020 (in comparison to 2019) in the European Institute of Oncology, IRCCS (IEO) in Milan and the South East London Cancer Alliance (SELCA). Both institutions implemented a COVID-19 minimal pathway where patients were required to self-isolate prior to admission and were swabbed for COVID-19 within 72 h of surgery. Positive patients had surgery deferred until a negative swab. At IEO, radical surgeries declined by 6% as compared to the same period in 2019 (n = 1477 vs. 1560, respectively). Readmissions were required for 3% (n = 41), and <1% (n = 9) developed COVID-19, of which only one had severe disease and died. At SELCA, radical surgeries declined by 34% (n = 1553 vs. 2336). Readmissions were required for 11% (n = 36), <1% (n = 7) developed COVID-19, and none died from it. Whilst a decline in number of surgeries was observed in both centres, the implemented COVID-19 minimal pathways have shown to be safe for cancer patients requiring radical treatment, with limited complications and almost no COVID-19 infections.

Keywords: COVID-19; cancer surgery; postoperative outcomes.

Figure 1

Chart illustrating: (a) weekly COVID-19 cases in Milan (and metropolitan area), and number of surgeries 1 March 2020–30 September 2020; (b) weekly SARS-CoV-2 (COVID-19) cases in London (and metropolitan area), and number of surgeries performed in South East London Cancer Alliance (SELCA) between 23 March 2019–8 September 2019 and 23 March 2020–8 September 2020.