ABSTRACT
Background: The COVID-19 pandemic has led to deviations in all sectors of cancer care. We present multidisciplinarily approved recommendations for ethically and empirically based prioritisation of procedures in times of scarce resources for patients with colorectal and pancreatic cancer. Method(s): The CancerCOVID consortium conducted qualitative and quantitative studies on ethical challenges and psychosocial stress of patients and health care professionals in cancer care. For empirical analyses we obtained data from AOK Plus, the main health insurance in Saxony, AIO (Arbeitsgemeinschaft internistische Onkologie) cancer centers, the institute of Pathology Bochum, the ColoPredict Registry and data of outpatient care from the BNHO (Berufsverband der Hamatologen und Onkologen) and Onkotrakt AG. A selective literature review of international data and guidelines focussing on the effects of the pandemic on cancer care and allocation of resources was conducted. Structured group discussions on justified criteria for prioritisation were held with experts from oncology, ethics, law and health research. Recommendations for prioritisation were formulated as S1 guideline with approval of 9 AWMF Medical Societies, 22 multidisciplinary experts and patient representatives. Result(s): The main principle for decisions on prioritisation in times of scarce resources is the minimisation of individual and aggregated harm. In case of relevant risk of harm from a possible low priority classification or postponement prioritization decisions should be made individually for the respective patients according to the multiple-eyes principle. Decision making should involve different disciplines and professions depending on local infrastructure. We concretised recommendations for 5 areas in cancer care. Conclusion(s): Guidelines based on a broad multidisciplinary consensus can give ethically and empirically based support in medical decision making when resources are scarce. This can provide relief for decision-makers and facilitate transparency and trust of patients and population.
ABSTRACT
Background: The effects of the COVID-19 pandemic on incidence, stage distribution, primary therapy, and delay in therapy were analyzed for breast cancer, prostate cancer, colorectal cancer, bronchial cancer, lymphoma and leukemia. Method(s): The years 2020 versus 2019 were compared with focus on the months of the first wave of pandemics from February to May 2020 analyzing data from the clinical cancer registry Regensburg. Result(s): The total numbers of annual new cases were lower in all entities in 2020 vs. 2019. The percentage decrease ranged between -1.9% for breast cancer and -15.3% for colorectal cancer, with highly significant difference for colorectal cancer (p<0.001). The comparison of the monthly reported number of cases showed a decrease in all analyzed cancer entities, in March to May 2020 compared to 2019 with statistical significance. There was no significantly increased rate of patients with advanced stages III/IV, larger tumors T3/T4, positive node status or distant metastases in nearly all entities neither in the annual nor the monthly comparison. Colorectal cancer was an exception, with significantly increased rates in March and April 2020. Apart from bronchial cancer, rates of primary therapy in stages I-III in 2020 were mostly slight, but not significantly lower than in 2019. Significantly lower treatment rates were found for prostate cancer in March 2020 and for colorectal cancer in November 2020. The mean interval between diagnosis and start of therapy was the same or slightly longer in 2020, but not significant, except for lung cancer, leukemia and lymphoma. Discussion(s): A potential lack in transmitted medical informations, a delay of documentation and consequently restricted real-time analysis must be considered when using data from clinical cancer registries. Conclusion(s): A decreased incidence especially during the first wave could be shown. A shift of stage distribution and treatment delay was not observed. Follow-up analyses and observation of the subsequent pandemic waves are necessary to confirm the current results.