Impact of COVID-19 on cancer service delivery: results from an international survey of oncology clinicians

Grace Chazan; Fanny Franchini; Marliese Alexander; Susana Banerjee; Linda Mileshkin; Prunella Blinman; Rob Zielinski; Deme Karikios; Nick Pavlakis; Solange Peters; Florian Lordick; David Ball; Gavin Wright; Maarten I Jzerman; Benjamin Solomon

doi:10.1136/esmoopen-2020-001090

Impact of COVID-19 on cancer service delivery: results from an international survey of oncology clinicians

ESMO Open. 2020 Dec;5(6):e001090. doi: 10.1136/esmoopen-2020-001090.

Authors

Affiliations

¹ Sir Peter MacCallum Department of Oncology, University of Melbourne Victorian Comprehensive Cancer Centre, Parkville, Victoria, Australia.
² Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia; Centre for Health Policy, University of Melbourne, Melbourne, Victoria, Australia.
³ Sir Peter MacCallum Department of Oncology, University of Melbourne Victorian Comprehensive Cancer Centre, Parkville, Victoria, Australia; Pharmacy Department, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
⁴ Gynaecology Unit, The Royal Marsden NHS Foundation Trust, London, UK; Division of Clinical Studies, The Institute of Cancer Research, London, UK.
⁵ Sir Peter MacCallum Department of Oncology, University of Melbourne Victorian Comprehensive Cancer Centre, Parkville, Victoria, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
⁶ Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia; Department of Medical Oncology, Concord Repatriation General Hospital, Concord, New South Wales, Australia.
⁷ School of Medicine, Western Sydney University, Penrith South, New South Wales, Australia; Department of Medical Oncology, Orange Base Hospital, Orange, New South Wales, Australia.
⁸ Department of Medical Oncology, Nepean Hospital, Penrith, New South Wales, Australia; Nepean Clinical School, The University of Sydney, Sydney, New South Wales, Australia.
⁹ Department of Medical Oncology, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
¹⁰ Department of Oncology, Lausanne University Hospital CHUV, Lausanne, Switzerland.
¹¹ Department of Institut Roi Albert II, University Cancer Centre Leipzig, Leipzig, Germany; Department of Oncology, Leipzig University Medical Center, Leipzig, Germany.
¹² Sir Peter MacCallum Department of Oncology, University of Melbourne Victorian Comprehensive Cancer Centre, Parkville, Victoria, Australia; Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
¹³ Department of Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia.
¹⁴ Sir Peter MacCallum Department of Oncology, University of Melbourne Victorian Comprehensive Cancer Centre, Parkville, Victoria, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia. Electronic address: ben.solomon@petermac.org.

Abstract

Objectives: To report clinician-perceived changes to cancer service delivery in response to COVID-19.

Design: Multidisciplinary Australasian cancer clinician survey in collaboration with the European Society of Medical Oncology.

Setting: Between May and June 2020 clinicians from 70 countries were surveyed; majority from Europe (n=196; 39%) with 1846 COVID-19 cases per million people, Australia (AUS)/New Zealand (NZ) (n=188; 38%) with 267/236 per million and Asia (n=75; 15%) with 121 per million at time of survey distribution.

Participants: Medical oncologists (n=372; 74%), radiation oncologists (n=91; 18%) and surgical oncologists (n=38; 8%).

Results: Eighty-nine per cent of clinicians reported altering clinical practices; more commonly among those with versus without patients diagnosed with COVID-19 (n=142; 93% vs n=225; 86%, p=0.03) but regardless of community transmission levels (p=0.26). More European clinicians (n=111; 66.1%) had treated patients diagnosed with COVID-19 compared with Asia (n=20; 27.8%) and AUS/NZ (n=8; 4.8%), p<0.001. Many clinicians (n=307; 71.4%) reported concerns that reduced access to standard treatments during the pandemic would negatively impact patient survival. The reported proportion of consultations using telehealth increased by 7.7-fold, with 25.1% (n=108) of clinicians concerned that patient survival would be worse due to this increase. Clinicians reviewed a median of 10 fewer outpatients/week (including non-face to face) compared with prior to the pandemic, translating to 5010 fewer specialist oncology visits per week among the surveyed group. Mental health was negatively impacted for 52.6% (n=190) of clinicians.

Conclusion: Clinicians reported widespread changes to oncology services, in regions of both high and low COVID-19 case numbers. Clinician concerns of potential negative impacts on patient outcomes warrant objective assessment, with system and policy implications for healthcare delivery at large.

Keywords: COVID-19; oncology; service delivery.

Publication types

Multicenter Study

MeSH terms

Adult
Asia / epidemiology
Australia / epidemiology
COVID-19 / epidemiology*
COVID-19 / virology
Europe / epidemiology
Female
Humans
Male
Medical Oncology / methods
Medical Oncology / statistics & numerical data
Neoplasms / epidemiology
Neoplasms / therapy*
Oncologists / statistics & numerical data
Pandemics
SARS-CoV-2 / isolation & purification
Surveys and Questionnaires