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. 2021 Nov;23(11):1656-1665.
doi: 10.1016/j.hpb.2021.03.003. Epub 2021 Mar 19.

Impact of SARS-CoV-2 pandemic on pancreatic cancer services and treatment pathways: United Kingdom experience

Siobhan C McKay  1 , Samir Pathak  2 , Richard J W Wilkin  3 , Sivesh K Kamarajah  4 , Stephen J Wigmore  5 , Jonathan Rees  6 , Declan F J Dunne  7 , Giuseppe Garcea  8 , Jawad Ahmad  9 , Nicola de Liguori Carino  10 , Asma Sultana  11 , Mike Silva  12 , Pavlos Lykoudis  13 , David Nasralla  14 , James Milburn  15 , Nehal Shah  16 , Hemant M Kocher  17 , Ricky Bhogal  18 , Ryan D Baron  19 , Alex Navarro  20 , James Halle-Smith  21 , Bilal Al-Sarireh  22 , Gourab Sen  23 , Nigel B Jamieson  24 , Christopher Briggs  25 , David Stell  26 , Somaiah Aroori  27 , Matthew Bowles  28 , Aditya Kanwar  29 , Simon Harper  30 , Krishna Menon  31 , Andreas Prachalias  32 , Parthi Srinivasan  33 , Adam E Frampton  34 , Claire Jones  35 , Ali Arshad  36 , Iain Tait  37 , Duncan Spalding  38 , Alastair L Young  39 , Damien Durkin  40 , Manijeh Ghods-Ghorbani  41 , Robert P Sutcliffe  42 , Keith J Roberts  43
Affiliations

Impact of SARS-CoV-2 pandemic on pancreatic cancer services and treatment pathways: United Kingdom experience

Siobhan C McKay et al. HPB (Oxford). 2021 Nov.

Abstract

Introduction: The SARS-CoV-2 pandemic presented healthcare providers with an extreme challenge to provide cancer services. The impact upon the diagnostic and treatment capacity to treat pancreatic cancer is unclear. This study aimed to identify national variation in treatment pathways during the pandemic.

Methods: A survey was distributed to all United Kingdom pancreatic specialist centres, to assess diagnostic, therapeutic and interventional services availability, and alterations in treatment pathways. A repeating methodology enabled assessment over time as the pandemic evolved.

Results: Responses were received from all 29 centres. Over the first six weeks of the pandemic, less than a quarter of centres had normal availability of diagnostic pathways and a fifth of centres had no capacity whatsoever to undertake surgery. As the pandemic progressed services have gradually improved though most centres remain constrained to some degree. One third of centres changed their standard resectable pathway from surgery-first to neoadjuvant chemotherapy. Elderly patients, and those with COPD were less likely to be offered treatment during the pandemic.

Conclusion: The COVID-19 pandemic has affected the capacity of the NHS to provide diagnostic and staging investigations for pancreatic cancer. The impact of revised treatment pathways has yet to be realised.

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Figures

Figure 1
Figure 1
Change in availability of diagnostic investigations and therapeutic interventions during SARS-CoV-2 pandemic per centre (EUS, endoscopic ultrasound; ERCP, endoscopic retrograde cholangiopancreatography; PTC, percutaneous transhepatic cholangiography; CT-PET, computer tomography positron emission tomography; Ltd availability, limited availability; N/A to normal pathway, not applicable to normal pathway)
Figure 2
Figure 2
Change in capacity for pancreatic cancer treatment during SARS-CoV-2 pandemic per centre
Figure 3
Figure 3
a-b: (a) Box-plot demonstrating change in number of pancreatic resections from during SARS-CoV-2 pandemic per centre compared to pre-pandemic baseline. (b) National number of pancreatic resections, bypasses, and bypass rate nationally during SARS-CoV-2 pandemic
Figure 4
Figure 4
Use of clinical vignettes to determine treatment variation during COVID pandemic: proportion of centres offering treatment for resectable pancreatic cancer stratified by age and COPD, prior to, and during the pandemic (COPD, chronic obstructive pulmonary disease)
Figure 5
Figure 5
A-B: Changes to standard treatment offered by centres for (A) resectable PDAC, (B) borderline resectable PDAC with vein involvement
Figure 6
Figure 6
COVID-status and type of centre pancreatic resections undertaken in during the SARS-CoV-2 pandemic
See this image and copyright information in PMC

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