Effect of COVID-19 pandemic lockdowns on planned cancer surgery for 15 tumour types in 61 countries: an international, prospective, cohort study

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Background: Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods: This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index <20), moderate lockdowns (20-60), and full lockdowns (>60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926. Findings: Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16-30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77-0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50-0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80-0·88; p<0·001), and full lockdowns (0·57, 0·
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Glasbey, James; Ademuyiwa, Adesoji; Adisa, Adewale; AlAmeer, Ehab; Arnaud, Alexis P; Ayasra, Faris; Azevedo, José; Minaya-Bravo, Ana; Costas-Chavarri, Ainhoa; Edwards, John; Elhadi, Muhammed; Fiore, Marco; Fotopoulou, Christina; Gallo, Gaetano; Ghosh, Dhruva; Griffiths, Ewen A; Harrison, Ewen; Hutchinson, Peter; Lawani, Ismail; Lawday, Samuel; Lederhuber, Hans; Leventoglu, Sezai; Li, Elizabeth; Gomes, Gustavo Mendonça Ataíde; Mann, Harvinder; Marson, Ella J; Martin, Janet; Mazingi, Dennis; McLean, Kenneth; Modolo, Maria; Moore, Rachel; Morton, Dion; Ntirenganya, Faustin; Pata, Francesco; Picciochi, Maria; Pockney, Peter; Ramos-De la Medina, Antonio; Roberts, Keith; Roslani, April Camilla; Kottayasamy Seenivasagam, Rajkumar; Shaw, Richard; Simões, Joana Filipa Ferreira; Smart, Neil; Stewart, Grant D; Sullivan, Richard; Sundar, Sudha; Tabiri, Stephen; Taylor, Elliott H; Vidya, Raghavan; Nepogodiev, Dmitri; Bhangu, Aneel; Glasbey, James C; McLean, Kenneth; Nepogodiev, Dmitri; Harrison, Ewen; Bhangu, Aneel A; Nepogodiev, Dmitri; Siaw-Acheampong, Kwabena; Benson, Ruth A; Bywater, Edward; Chaudhry, Daoud; Dawson, Brett E; Evans, Jonathan P; Glasbey, James C; Gujjuri, Rohan R; Heritage, Emily; Jones, Conor S; Kamarajah, Sivesh K; Khatri, Chetan; Khaw, Rachel A; Keatley, James M; Knight, Andrew; Lawday, Samuel; Li, Elizabeth; Mann, Harvinder S; Marson, Ella J; McLean, Kenneth A; Mckay, Siobhan C; Mills, Emily C; Pellino, Gianluca; Picciochi, Maria; Taylor, Elliott H; Tiwari, Abhinav; Simoes, Joana FF; Trout, Isobel M; Venn, Mary L; Wilkin, Richard JW; Bhangu, Aneel; Glasbey, James C; Smart, Neil J; Minaya-Bravo, Ana; Evans, Jonathan P; Gallo, Gaetano; Moug, Susan; Pata, Francesco; Pockney, Peter; Di Saverio, Salomone; Vallance, Abigail; Vimalchandran, Dale; Griffiths, Ewen A; Kamarajah, Sivesh K; Evans, Richard PT; Townend, Philip; Roberts, Keith; McKay, Siobhan; Isaac, John; Satoi, Sohei; Edwards, John; Coonar, Aman S; Marchbank, Adrian; Caruana, Edward J; Layton, Georgia
Glasbey, J; Ademuyiwa, A; Adisa, A; Alameer, E; Arnaud, A; Ayasra, F; Azevedo, J; Minaya-Bravo, A; Costas-Chavarri, A; Edwards, J; Elhadi, M; Fiore, M; Fotopoulou, C; Gallo, G; Ghosh, D; Griffiths, E; Harrison, E; Hutchinson, P; Lawani, I; Lawday, S; Lederhuber, H; Leventoglu, S; Li, E; Gomes, G; Mann, H; Marson, E; Martin, J; Mazingi, D; Mclean, K; Modolo, M; Moore, R; Morton, D; Ntirenganya, F; Pata, F; Picciochi, M; Pockney, P; Ramos-De la Medina, A; Roberts, K; Roslani, A; Kottayasamy Seenivasagam, R; Shaw, R; Simões, J; Smart, N; Stewart, G; Sullivan, R; Sundar, S; Tabiri, S; Taylor, E; Vidya, R; Nepogodiev, D; Bhangu, A; Glasbey, J; Mclean, K; Nepogodiev, D; Harrison, E; Bhangu, A; Nepogodiev, D; Siaw-Acheampong, K; Benson, R; Bywater, E; Chaudhry, D; Dawson, B; Evans, J; Glasbey, J; Gujjuri, R; Heritage, E; Jones, C; Kamarajah, S; Khatri, C; Khaw, R; Keatley, J; Knight, A; Lawday, S; Li, E; Mann, H; Marson, E; Mclean, K; Mckay, S; Mills, E; Pellino, G; Picciochi, M; Taylor, E; Tiwari, A; Simoes, J; Trout, I; Venn, M; Wilkin, R; Bhangu, A; Glasbey, J; Smart, N; Minaya-Bravo, A; Evans, J; Gallo, G; Moug, S; Pata, F; Pockney, P; Di Saverio, S; Vallance, A; Vimalchandran, D; Griffiths, E; Kamarajah, S; Evans, R; Townend, P; Roberts, K; Mckay, S; Isaac, J; Satoi, S; Edwards, J; Coonar, A; Marchbank, A; Caruana, E; Layton, G; Patel, A; Brunelli, A; Ford, S; Desai, A; Gronchi, A; Fiore, M; Almond, M; Tirotta, F; Dumitra, S; Kolias, A; Price, S; Fountain, D; Jenkinson, M; Hutchinson, P; Marcus, H; Piper, R; Lippa, L; Servadei, F; Esene, I; Freyschlag, C; Neville, I; Rosseau, G; Schaller, K; Demetriades, A; Robertson, F; Alamri, A; Shaw, R; Schache, A; Winter, S; Ho, M; Nankivell, P; Rey Biel, J; Batstone, M; Ganly, I; Vidya, R; Wilkins, A; Singh, J; Thekinkattil, D; Sundar, S; Fotopoulou, C; Leung, E; Khan, T; Chiva, L; Sehouli, J; Fagotti, A; Cohen, P; Gutelkin, M; Ghebre, R; Konney, T; Pareja, R; Bristow, R; Dowdy, S; Shylasree, T; Kottayasamy Seenivasagam, R; Ng