ABSTRACT
BACKGROUND: This study aimed to assess the impact of multiple COVID-19 waves on UK gynaecological-oncology services. METHODS: An online survey was distributed to all UK-British-Gynaecological-Cancer-Society members during three COVID-19 waves from 2020 to2022. RESULTS: In total, 51 hospitals (including 32 cancer centres) responded to Survey 1, 42 hospitals (29 centres) to Survey 2, and 39 hospitals (30 centres) to Survey 3. During the first wave, urgent referrals reportedly fell by a median of 50% (IQR = 25-70%). In total, 49% hospitals reported reduced staffing, and the greatest was noted for trainee doctors, by a median of 40%. Theatre capacity was reduced by a median of 40%. A median of 30% of planned operations was postponed. Multidisciplinary meetings were completely virtual in 39% and mixed in 65% of the total. A median of 75% of outpatient consultations were remote. By the second wave, fewer hospitals reported staffing reductions, and there was a return to pre-pandemic urgent referrals and multidisciplinary workloads. Theatre capacity was reduced by a median of 10%, with 5% of operations postponed. The third wave demonstrated worsening staff reductions similar to Wave 1, primarily from sickness. Pre-pandemic levels of urgent referrals/workload continued, with little reduction in surgical capacity. CONCLUSION: COVID-19 led to a significant disruption of gynaecological-cancer care across the UK, including reduced staffing, urgent referrals, theatre capacity, and working practice changes. Whilst disruption eased and referrals/workloads returned to normal, significant staff shortages remained in 2022, highlighting persistent capacity constraints.
ABSTRACT
Introduction/BackgroundCOVID-19 has significantly impacted all areas of medicine including access to primary care. The majority of women with endometrial cancer present in early stages and have promising survival outcomes. The concern is that COVID-19 has caused potential delays in diagnosis leading to patients requiring more extensive surgical management and affecting disease outcomes.MethodologyAll patients diagnosed with endometrial cancer in 2019 (pre COVID-19), 2020 (during peak of COVID-19) and 2021 (during COVID-19 recovery) were included. Patients with myometrial sarcoma, other myometrial tumours and endometrial cancer recurrences were excluded. Data was collected electronically including histology, FIGO stage at diagnosis, symptom duration, parity, BMI, surgical location (regional cancer centre vs cancer unit), surgical approach and type, complications, adjuvant treatment and survival status. Statistical analysis was then performed.Results639 were patients identified in total (194 in 2019, 216 in 2020 and 229 in 2021). Provisional data appears to show that during COVID-19 patients present with higher FIGO stage, undergo more open surgical procedures and more extensive surgery to manage their endometrial malignancy.ConclusionCOVID-19 appears to have impacted the diagnostic and treatment pathways of women with endometrial cancer in NI. This could be due to the postponement of laparoscopic surgery following the potential risk of aerosol generation and potential delays in diagnosis due to difficult access to primary care.