The ManicaPost
CANCER treatment was heavily disrupted during the first wave of Covid-19, with many having their treatment delayed or altered because of the potential risks of Covid-19, or due to demands on the NHS during the pandemic.
Since the start of the pandemic, researchers have been working hard not only to monitor the impact of Covid-19 on people’s treatment, but also to understand the Covid-19 related risks of individual treatment options to help doctors and people with cancer make more informed decisions in future waves.
The biggest question mark was around surgery.
Surgery was the worst hit during the first wave, mainly because of the demand for intensive care unit (ICU) beds. But there were also questions about risk, as having a big operation involving a hospital stay can make it more likely that someone will get an infection.
A large, international, ongoing study is aiming to answer questions about surgery and risk of severe outcomes from Covid-19. Findings from the COVIDSurg study have shown that having Covid-19 around the time of surgery — not just cancer surgery — leads to worse outcomes than were seen pre-pandemic, including higher rates of lung complications and higher risk of death. This initial data mainly looked at emergency surgeries, so may not be applicable to surgery in general.
COVIDSurg has begun to look at whether having had Covid-19 affects outcomes in people undergoing suspected cancer surgery. We don’t have the full findings yet, but initial results suggest that previous COVID-19 infection can increase the risk of lung complications.
The international team has also compared outcomes for patients undergoing cancer surgery in a Covid-protected environment with those having surgery in a hospital with no defined Covid-protected pathway during the height of the first wave. And the good news is it looks like Covid-protected environments do make a difference — rates of lung complications, Covid-19 infections following surgery and deaths were low in patients treated in a Covid-protected environment.
This has been backed up by several other studies suggesting that it’s safe and feasible for patients to have elective cancer surgery in Covid-protected safe spaces in the UK.
Analysis of surgery for specific types of cancer is now starting to become available. International data from the first wave of the pandemic on over 2000 patients with colon or rectal cancer showed that most of these patients did not develop Covid-19 in the period after surgery. Developing COVID-19 in the period after surgery and complications after surgery were both associated with worse outcomes for patients.
COVIDSurg data are also now available of patients with head and neck cancers, a particular concern because of the chances of spreading infection by operating in the airway.
The analysis of 1 137 patients shows that the majority did not develop Covid-19 in the period after surgery and that their outcomes were similar to those normally expected from this group of patients. While this suggests that the measures introduced to make surgery safer are working, there was an association between patients and members of the surgical team testing positive.
This can probably be explained by in part by high levels of infection in the community. The data also show differences in the types of head and neck cancer patients having surgery to what you would normally expect to see suggesting that some patients received alternative treatment.
Beyond surgery, some people with cancer have also had changes made to their systemic anticancer treatment or the way in which this treatment has been provided to try to minimise their risk.
For example, a switch to an oral treatment that can be taken at home rather than in hospital, or to a different drug with fewer side effects to reduce the impact on the immune system.
Radiotherapy was perhaps the least impacted type of cancer treatment and, in some cases, was even used as a treatment option for people who couldn’t have surgery or other treatments.
There were some changes to radiotherapy — some patients were able to have the same overall dose of radiation in fewer visits to the hospital, reducing the risk of being infected. — Online.
