COVID-19 pandemic has had a significant impact on the provision of healthcare worldwide. At a local level, hospitals have been forced to make a number of work-force modifications and changes to service-provision to combat the crisis and maintain standards of care for their patients. In Colorectal Surgical departments, face-to-face consultations have been dissolved or minimized in favour of telephone or virtual clinics. Provisions of investigations (including CT scans and endoscopies) have been significantly reduced and all benign surgical procedures postponed. Furthermore, the treatment algorithm for confirmed colorectal cancer cases has proved challenging. Intercollegiate General Surgery Guidance on COVID-19 has outlined general principles on provision of a safe surgical service during the pandemic. However, there has been no specific guidance to date on how to best modify colorectal cancer (CRC) service provision during the pandemic.
Deviation from NICE guidelines on colorectal cancer service provision has the potential to lead to significantly poorer outcomes. However, the current model of cancer services delivery cannot be maintained during this pandemic, because of both resource limitation and the potential risks to patients and staff. There is an expected lack of High Dependency Beds, which are currently being utilized for COVID-19 patients. There is the risk of exposing colorectal cancer patients (the majority of whom are elderly and have significant comorbidities) to the virus during their treatment within the hospital. Patients requiring neo-adjuvant or adjuvant therapy are at particular risk. Finally staff safety must also be considered, particularly around procedures such as endoscopy and laparoscopic surgery.
In the absence of a national consensus, the onus is on individual hospital trusts and multidisciplinary teams to make very challenging decisions about individual patient care. Lack of a unified approach may have important consequences at patient and healthcare institution levels. Delay in cancer diagnosis, or treatment due to service modification is likely to create an increased demand in resources once the crisis has passed. Predicting the economic impact and planning for this is essential.
Resource allocation and approach to theses issues may vary between the UK and USA and it is hoped that gaining insights from both perspectives will improve the problem solving.