Going Virtual: Effect of Implementing Video Visits On Readmission Rates in Gi Surgical Oncology Patients

Introduction: The COVID-19 pandemic introduced a sudden need to decrease in-person visits. While many elective operations were postponed or canceled, GI cancers cases continued since treatment delay would risk disease progression. To mitigate contact risks, virtual postoperative visits replaced traditional encounters in the majority of patients. This study evaluates whether the shift to virtual postoperative visits increased hospital readmissions. Method(s): The Epic Clarity database was used to develop a retrospective cohort of patients undergoing inpatient oncologic operations. Readmission was compared Pre and Post-Covid with further analysis between Telehealth and In-Person subgroups in the Post- Covid cohort. A combination of univariate and multivariate logistic regressions was conducted on 30-day readmissions from the index admission. Result(s): The cohort consisted of 1,926 patients in the Pre- Covid timeframe and 1,064 patients in the Post-Covid, 699 (65.7%) Telehealth and 365 (34.3%) In-person follow-up visits. The readmission rate was 6.9% Pre-Covid and 7.2% Post-Covid (p=0.447) which did not change despite the shift to Telehealth. Those seen in-person Post-Covid visits were 46% more likely to be readmitted (p=0.026). Conclusion(s): Swift implementation of virtual clinics during the COVID-19 pandemic enabled video-based follow-up for the majority of GI oncology postoperative patients. Despite the high adoption of virtual follow-up visits, readmission rates did not increase. Further, higher readmissions in the Covid In-Person cohort suggest high-risk patients can effectively be identified and screened for in-person evaluation. Ongoing analysis is focused onidentifying a patient characteristic model for selecting appropriate postsurgical follow up.

Breast Cancer-Related Lymphedema and its Relationship to Major Landmark Trials in Surgical Oncology and Radiation Oncology

INTRODUCTION: Many landmark trials have challenged the need for extensive axillary surgery and radiation in breast cancer patients. De-escalation of axillary treatment could potentially result in less breast cancer-related lymphedema (BCRL). Our study aims to define the incidence and trends of BRCL over the last 15 years. METHOD(S): Since 2005, our institution has prospectively screened breast cancer patients for lymphedema during and after treatment with a Perometer. 2,334 women diagnosed with breast cancer with baseline arm volume measurements and at least 2 follow-up measurements were divided into 3 cohorts based on date of surgery (Cohort 1: 2005-2010, Cohort 2:2011-2016, Cohort 3: 2016-2022). The cohorts were selected to coincide with publications of the landmark trials NSABP B-32, ASCOG Z0011, ASCOG Z1071, and EORTC 10981-22023 AMAROS which demonstrated safety in reducing the number of axillary lymph node dissections (ALND). Lymphedema was defined as a relative volume change of 10% or greater from preoperative baseline at least 3 months post-operatively. In cases of bilateral surgery, the weight-adjusted arm volume change equation was utilized. Cohort, age, BMI, axillary surgery type, chemotherapy timing, radiation type, and surgery type were all included in the multivariate analysis. RESULT(S): The overall incidence of BCRL was 12.8%, with a 29.6% incidence for those undergoing ALND and a 6.4% incidence for those undergoing sentinel lymph node biopsy. While the number of ALND performed decreased between cohorts (Figure 1), there was no significant difference in BCRL between assigned cohorts (HR 1.02 (95% CI [0.69, 1.51], p=0.930 for cohort 3 vs cohort 1). On multivariate analysis, significant associations with development of BCRL were identified with older age (HR 1.02;95% CI [1.01, 1.03], p=0.002), higher BMI (HR 1.05;95% CI [1.04, 1.07], p< 0.0001) and ALND (HR increased the risk of (HR 3.67;95% CI [2.62, 5.13], p< .0001). Regional lymph node radiation was not significantly associated with BCRL. CONCLUSION(S): Despite a reduction in the number of ALND performed over time, we did not see a dramatic reduction in the incidence of BCRL. Interestingly, between cohort 2 and cohort 3 there was a stable incidence of ALND which could be related to the COVID pandemic with an increase in more advanced cancers and a decrease in the ability to screen patients for BCRL during that time period.

Multidisciplinary Virtual Tumor Boards (VTB): A Single Center Satisfaction Survey

INTRODUCTION: With the onset of the COVID-19 pandemic, many cancer centers pivoted to a completely virtual multidisciplinary tumor board (VTB) format. We previously published a significant rise in number of attendees and cases presented with the transition from in-person to VTB at our institution. The aim of the current study was to measure the satisfaction of participants regarding the virtual format. METHOD(S): We developed a 21-question survey including 10 questions that directly compared virtual to in-person tumor boards using a 5-point Likert scale. The survey was imported into REDCap and sent via email to all tumor board participants. Responses were collected for approximately 4 weeks (reminder email at 2 weeks) and categorized. RESULT(S): There were a total of 83 respondents, 53 of whom (64%) attended both in-person and VTB. Specialties with highest response rates were Surgical Oncology (n=24) and Medical Oncology (n=18), and tumor boards with highest participation in the survey were Breast (n=26) and Gastrointestinal (n=21). Most respondents accessed the virtual platform from the hospital or office (67%) with some participation from home (19%). Most (77%) participants were either satisfied or very satisfied with the VTB format compared with 70% for in-person tumor board. Additionally, the majority of respondents (95%) felt that VTBs had great value for discussions with community-based clinicians. In terms of direct comparison to in-person tumor boards, 40% felt that the level of distraction was higher for VTB. The large majority of respondents felt that they were somewhat more (24%) or significantly more (44%) available for VTB format. Finally, when asked regarding their preference going forward, 52% favored virtual, 6% favored in-person, and 42% favored some sort of hybrid variety type of tumor board. CONCLUSION(S): The majority of multidisciplinary tumor board participants expressed satisfaction with the virtual format and prefer it to in-person meetings going forward. VTB allows increased accessibility, opportunities to engage community oncologists, and the ability to present more cases. Drawbacks to this format included less face-to-face interaction and increased levels of distraction. Our institution is currently considering completely virtual and hybrid options moving forward.

Two-Week Wait Gastrointestinal (GI) Cancer Pathway: A Single Tertiary Centre Experience During the COVID-19 Pandemic.

BACKGROUND: This article investigated the impact of COVID-19 on the two-week wait referral pathway at the University Hospitals of Leicester NHS Trust. The conversion rate of these referrals was also explored as an indicator of the appropriateness of referrals from primary care. METHODS: Two-week wait referrals to the Cancer Centre of the University Hospitals of Leicester NHS Trust from 2018 to 2020 were collected for upper gastrointestinal (UGI), lower gastrointestinal (LGI), and hepato-pancreato-biliary (HPB) surgery. The confirmed cancer cases out of these referrals were also recorded. Additionally, the outcomes of the multidisciplinary team (MDT) meetings for all patients discussed in June 2018, 2019, and 2020 were collected, and their staging and treatment data were examined. RESULTS: The number of two-week referrals decreased in 2020 compared to the previous two years across the three specialities. This was more pronounced in April, with a reduction of over 50%. The conversion rate of these referrals increased in 2020 compared to 2018 and 2019 among all three specialities. The increase in conversion rate was statistically significant for LGI referrals (2018 vs 2020 p = 0.0056; 2019 vs 2020 p = 0.0005). There was no significant difference in the MDT outcome across the three specialities. CONCLUSION: Two-week wait remains a cornerstone pathway in the management of patients with suspected cancer in the National Health Service. The COVID-19 pandemic appeared to have reduced inappropriate referrals, as evidenced by the increased conversion rate. This did not appear to negatively impact tumour staging and outcomes for those patients who were referred on the pathway.

Radical abdomino-pelvic surgery in the management of uterine carcinosarcoma with concomitant para-aortic lymphadenopathy metastasising from anal carcinoma.

Uterine carcinosarcomas are aggressive gynaecological cancers comprising less than 5% of uterine malignancies. We present the case of a woman in her 70s with a complicated history of advanced anal carcinoma treated with pelvic radiotherapy and multiple laparotomies, who was referred to gynae-oncology following MRI surveillance imaging showing evidence of endometrial carcinoma and para-aortic lymphadenopathy. Successful surgical excision required multidisciplinary teamwork between gynae-oncology, colorectal and urology surgeons. The patient underwent midline laparotomy, with adhesiolysis, ileum resection and side to side anastomosis, posterior exenteration, left kidney mobilisation and suspension, para-aortic lymph node debulking and left ureteric stent insertion. Significant challenge was posed by the extensive adhesions from previous laparotomies and the debulking of the para-aortic lymph nodes around the renal vessels. This case demonstrates the importance of a multidisciplinary approach in complex pelvic surgery and the vitality of good communication between colleagues in achieving effective patient care.

Follow-up in breast cancer care: guidelines and individual risks

The aim of this study was to investigate how breast cancer follow-up in the Netherlands changed during the COVID-19 pandemic, compared to 2018-2019, and to what extent follow-up during the pandemic corresponded to the patient risk of recurrence. During the early phase of the pandemic the Dutch Society for Surgical Oncology (NVCO) issued a report with recommendations on how follow-up could be postponed, as a guidance for the pandemic, based on a low, intermediate or high risk of recurrence. In this study we investigated to what extent this advice was followed. A dataset of 33160 women diagnosed with primary invasive breast cancer between January of 2017 and July of 2021 was selected from the Netherlands Cancer Registry (NCR) and Dutch Hospital Data (DHD). The pandemic, 2020 and weeks 1-32 of 2021, was divided into six periods (A to F), based on the number of hospitalized COVID patients in the Netherlands. The five-year risk of locoregional recurrence (LRR) was determined for each patient with the INFLUENCE nomogram. The LRR risk was compared to the risk groups from the NVCO report with a Kruskal-Wallis test. The percentage of patients who received a mammogram during period A to F was compared to the same periods of 2018-2019 with a chisquared test. Correlation between the LRR risk, and if patients had a mammogram, was investigated with logistic regression. This analysis was repeated separately for the risk groups. Correlation between the LRR risk, and time intervals between surgery and the first and second mammogram was analyzed using cox proportional hazard models, this was also repeated for the risk groups. There was a significant difference in LRR risk between the NVCO risk groups. In the low-risk group (n=7673), 86 patients (1.1%) had a risk >5%. In the intermediate risk group (n=19197), 18364 patients (95.7%) had a risk of < 5%, and 65 patients (0.34%) had a risk of >10%. In the high-risk group (n=2674), 2365 patients (88.4%) had a risk < 10%. The percentage of patients who received a mammogram was significantly lower in periods B to F of the pandemic. Logistic regression showed a negative correlation between the risk of LRR and if patients had a mammogram in 2020 (OR 0.93) and 2021 (OR 0.93). There was also a negative correlation between the risk groups and mammography in 2020 (OR 0.92 for intermediate and 0.80 for high), and for the risk groups and mammography in 2021 (OR 0.98 for intermediate and 0.95 for high). There was no significant impact of LRR risk, or risk group, on time intervals between mammograms. During the pandemic, patients with a higher LRR risk, or a higher risk according to NVCO advice, had lower odds of having a mammogram. If the advice would have been followed, in 0.5% of the patients scheduled for follow-up, the recommendation was to postpone in contrast to a high estimation of the individual risk. For 62.7%, a follow-up was recommended, despite a low estimated individuals risk. Because the number of high-risk patients is relatively low, individual risk prediction could be supportive, in case of future restrictions. This way the high-risk patients can be identified and prioritized for follow-up, and can also be encouraged to come to the hospital.

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic.

AIM: This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic. METHOD: This was an international cohort study of patients undergoing elective resection of colon or rectal cancer without preoperative suspicion of SARS-CoV-2. Centres entered data from their first recorded case of COVID-19 until 19 April 2020. The primary outcome was 30-day mortality. Secondary outcomes included anastomotic leak, postoperative SARS-CoV-2 and a comparison with prepandemic European Society of Coloproctology cohort data. RESULTS: From 2073 patients in 40 countries, 1.3% (27/2073) had a defunctioning stoma and 3.0% (63/2073) had an end stoma instead of an anastomosis only. Thirty-day mortality was 1.8% (38/2073), the incidence of postoperative SARS-CoV-2 was 3.8% (78/2073) and the anastomotic leak rate was 4.9% (86/1738). Mortality was lowest in patients without a leak or SARS-CoV-2 (14/1601, 0.9%) and highest in patients with both a leak and SARS-CoV-2 (5/13, 38.5%). Mortality was independently associated with anastomotic leak (adjusted odds ratio 6.01, 95% confidence interval 2.58-14.06), postoperative SARS-CoV-2 (16.90, 7.86-36.38), male sex (2.46, 1.01-5.93), age >70 years (2.87, 1.32-6.20) and advanced cancer stage (3.43, 1.16-10.21). Compared with prepandemic data, there were fewer anastomotic leaks (4.9% versus 7.7%) and an overall shorter length of stay (6 versus 7 days) but higher mortality (1.7% versus 1.1%). CONCLUSION: Surgeons need to further mitigate against both SARS-CoV-2 and anastomotic leak when offering surgery during current and future COVID-19 waves based on patient, operative and organizational risks.

The Effects of the COVID-19 Pandemic on Mastectomy Outcomes for Breast Cancer.

BACKGROUND: Single center studies have shown that during the Coronavirus Disease 2019 (COVID-19) pandemic, many patients had surgical procedures postponed or modified. We studied how the pandemic affected the clinical outcomes of breast cancer patients who underwent mastectomies in 2020. METHODS: Using the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database, we compared clinical variables of 31,123 and 28,680 breast cancer patients who underwent a mastectomy in 2019 and 2020, respectively. Data from 2019 served as the control, and data from 2020 represented the COVID-19 cohort. RESULTS: Fewer surgeries of all kinds were performed in the COVID-19 year than in the control (902,968 vs. 1,076,411). The proportion of mastectomies performed in the COVID-19 cohort was greater than in the control year (3.18% vs. 2.89%, <0.001). More patients presented with ASA level 3 in the COVID-19 year vs. the control (P < .002). Additionally, the proportion of patients with disseminated cancer was lower during the COVID-19 year (P < .001). Average hospital length of stay (P < .001) and time from operation to discharge were shorter in the COVID vs. control cohort (P < .001). Fewer unplanned readmissions were seen in the COVID year (P < .004). CONCLUSION: The ongoing surgical services and mastectomies for breast cancer during the pandemic produced similar clinical outcomes to those seen in 2019. Prioritization of resources for sicker patients and the use of alternative interventions produced similar results for breast cancer patients who underwent a mastectomy in 2020.

Incidental giant thymoma-a reminder of the importance of a global look of the imaging scans.

A 49-year-old female patient, without previous medical history, underwent a thoracic CT due to SARS-CoV2 infection. This exam revealed a heterogeneous mass in the anterior mediastinum with 11 × 8.8 cm in close contact with main thoracic vessels and pericardium. Surgical biopsy documented a B2 thymoma. This clinical case reminds the importance of a systematic and global look of the imaging scans. Years before the thymoma diagnosis, the patient underwent a shoulder X-ray due to musculoskeletal pain, where an irregular shape of the aortic arch was visible, probably related to the growing mediastinal mass. An earlier diagnosis would allow a complete mass resection without such extensive surgery and less morbidity.

Patient and caregiver experience with telehealth for surgical cancer care: A qualitative study.

INTRODUCTION: The COVID-19 pandemic led to telemedicine adoption for many medical specialties, including surgical cancer care. To date, the evidence for patient experience of telemedicine among patients with cancer undergoing surgery is limited to quantitative surveys. Thus, this study qualitatively assessed the patient and caregiver experience of telehealth visits for surgical cancer care. METHODS: We conducted semistructured interviews with 25 patients with cancer and three caregivers who had completed a telehealth visit for preanesthesia or postoperative visits. Interviews covered visit descriptions, overall satisfaction, system experience, visit quality, what roles caregivers had, and thoughts on what types of surgery-related visits would be appropriate through telehealth versus in-person. RESULTS: Telehealth delivery for surgical cancer care was generally viewed positively. Multiple factors influenced the patient experience, including prior experience with telemedicine, ease of scheduling visits, smooth connection experiences, having access to technical support, high communication quality, and visit thoroughness. Participants identified use cases on telehealth for surgical cancer care, including postoperative visits for uncomplicated surgical procedures and educational visits. CONCLUSIONS: Patient experiences with telehealth for surgical care are influenced by smooth system experiences, high-quality patient-clinician communications, and a patient-centered focus. Interventions are needed to optimize telehealth delivery (e.g., improve telemedicine platform usability).

Surgical oncology during the post-COVID-19 era: What is next?

During first outburst of COVID-19, several strategies had been applied for surgical oncology patients to minimize COVID-19 transmission. COVID-19 infection seemed to compromise survival and major complication rates of surgical oncology patients. However, survival, tumor progression and recurrence rates of surgical oncology patients were associated to the consequences of COVID-19 pandemic on their management. In addition, the severity of COVID-19 infections has been downgraded. Therefore, management of surgical oncology patients should be reconsidered. © 2022 Wiley Periodicals LLC.

Same day discharge for robot-assisted radical prostatectomy: a prospective cohort study documenting an Australian approach.

BACKGROUND: The introduction of robotic surgical systems has significantly impacted urological surgery, arguably more so than other surgical disciplines. The focus of our study was length of hospital stay - patients have traditionally been discharged day 1 post-robot-assisted radical prostatectomy (RARP), however, during the ongoing COVID-19 pandemic and consequential resource limitations, our centre has facilitated a cohort of same-day discharges with initial success. METHODS: We conducted a prospective tertiary single-centre cohort study of a series of all patients (n = 28) - undergoing RARP between January and April 2021. All patients were considered for a day zero discharge pathway which consisted of strict inclusion criteria. At follow-up, each patient's perspective on their experience was assessed using a validated post-operative satisfaction questionnaire. Data were reviewed retrospectively for all those undergoing RARP over the study period, with day zero patients compared to overnight patients. RESULTS: Overall, 28 patients 20 (71%) fulfilled the objective criteria for day zero discharge. Eleven patients (55%) agreed pre-operatively to day zero discharge and all were successfully discharged on the same day as their procedure. There was no statistically significant difference in age, BMI, ASA, Charlson score or disease volume. All patients indicated a high level of satisfaction with their procedure. Median time from completion of surgery to discharge was 426 min (7.1 h) in the day zero discharge cohort. CONCLUSION: Day zero discharge for RARP appears to deliver high satisfaction, oncological and safety outcomes. Therefore, our study demonstrates early success with unsupported same-day discharge in carefully selected and pre-counselled patients.

A First Reported Adjustable Breast Volume Simulator for Teaching Oncoplastic Surgery Marking: Adjustable Breast Oncoplastic Surgery Simulator.

BACKGROUND: The current simulators for teaching oncoplastic surgery marking are available in a fixed size for each model. This is not an accurate reflection of the variety of patient's breast volumes in reality and may limit the teaching to certain techniques associated with the particular breast ptosis/size. DEVICE DESCRIPTION: This is the first reported simulator with varying breast volumes/ptosis in a single model for teaching oncoplastic surgery marking, known as Adjustable Breast Oncoplastic Surgery Simulator (ABOSS). Adjustable Breast Oncoplastic Surgery Simulator was created using 3D printing. PRELIMINARY RESULTS: Adjustable Breast Oncoplastic Surgery Simulator could simulate the breast in appearance and texture. It is inexpensive and allows the practice of various markings based on the different breast volumes/ptosis in a single model. It also allows for the practice of the marking needed in asymmetric breasts to correct the asymmetry. CURRENT STATUS: Plans for commercialisation were made.

The Impact of the COVID-19 Pandemic on Surgical Activities: A Single-Center Experience and Literature Review.

Aim The aim of this article is to investigate the effect of the coronavirus disease 2019 (COVID-19) pandemic on our surgical department, which is situated in Athens, Greece, as well as to review published literature on the COVID-19 pandemic's impact on surgical activities in our department.  Material and methods We retrospectively reviewed the surgical procedures that were performed in the surgical department of a tertiary University hospital in Athens, Greece, before and during the pandemic. Furthermore, we performed a literature review evaluating articles on surgical activity and COVID-19 published from the beginning of the pandemic up until the January of 2022 on the PubMed database.  Results In total, 894 patients were included in the study. Of those, 264 (29.5%) underwent surgery during the control period and 630 (70.5%) in the pandemic period. Overall, we performed 20.5% fewer surgeries in the post-sanitary period. In particular, elective surgeries decreased on average by 23.9%, emergency procedures decreased by 8.9%, and oncology surgeries increased by an average of 6.4% after the year 2020. Concerning the review of literature, 51 studies were selected for this review. According to them, the main effect of the pandemic on the surgical sector was reflected in the reduction of total surgeries, mainly due to the postponement of elective surgical procedures, which showed a median reduction of 54% compared to the pre-COVID-19 period. A smaller decrease was observed in the number of emergency and oncological surgeries. Conclusions Reduced surgical activity during the pandemic, due to the health measures imposed, requires courageous corrective interventions to avoid its adverse effects, such as disease progression, increased treatment costs, reduced quality of life, and ultimately the survival of the patients.

Association between COVID-19 Burden, Population Vaccination Status, and Urologic Oncology Surgery Volume: A National Multicenter Cross-Sectional Study.

Initial deleterious effects of the COVID-19 pandemic on urologic oncology surgeries are well described, but the possible influence of vaccination efforts and those of pandemic conditions on surgical volumes is unclear. Our aim was to examine the association between changing vaccination status and COVID-19 burden throughout the pandemic and the volume of urologic oncology surgeries in Israel. This multi-center cross-sectional study included data collected from five tertiary centers between January 2019 and December 2021. All 7327 urologic oncology surgeries were included. Epidemiological data were obtained from the Israeli Ministry of Health database. A rising trend in total urologic oncology surgery volumes was observed with ensuing COVID-19 wave peaks over time (X2 = 13.184, df = 3, p = 0.004). Total monthly surgical volumes correlated with total monthly hospitalizations due to COVID-19 (R = -0.36, p = 0.015), as well as with the monthly average Oxford Stringency Index (R = -0.31, p = 0.035). The cumulative percent of vaccinations and of new COVID-19 cases per month did not correlate with total monthly urologic surgery volumes. Our study demonstrates the gradual acclimation of the Israeli healthcare system to the COVID-19 pandemic. However, hospitalizations due to COVID-19, as well as restriction stringency, correlate with lower volumes of urologic oncological surgeries, regardless of the population's vaccination status.

Systematic review and meta-analysis determining the effect of implemented COVID-19 guidelines on surgical oncology volumes and clinical outcomes.

BACKGROUND: To provide for Coronavirus Disease 2019 (COVID-19) healthcare capacity, (surgical oncology) guidelines were established, forcing to alter the timing of performing surgical procedures. It is essential to determine whether these guidelines have led to disease progression. This study aims to give an insight into the number of surgical oncology procedures performed during the pandemic and provide information on short-term clinical outcomes. MATERIALS AND METHODS: A systematic literature search was performed on all COVID-19 articles including operated patients, published before March 21, 2022. Meta-analysis was performed to visualize the number of performed surgical oncology procedures during the pandemic compared to the pre-pandemic period. Random effects models were used for evaluating short-term clinical outcomes. RESULTS: Twenty-four studies containing 6762 patients who underwent a surgical oncology procedure during the pandemic were included. The number of performed surgical procedures for an oncological pathology decreased (-26.4%) during the pandemic. The number of performed surgical procedures for breast cancer remained stable (+0.3%). Moreover, no difference was identified in the number of ≥T2 (OR 1.00, P = 0.989), ≥T3 (OR 0.95, P = 0.778), ≥N1 (OR 1.01, P = 0.964) and major postoperative complications (OR 1.55, P = 0.134) during the pandemic. CONCLUSION: The number of performed surgical oncology procedures during the COVID-19 pandemic decreased. In addition, the number of performed surgical breast cancer procedures remained stable. Oncological staging and major postoperative complications showed no significant difference compared to pre-pandemic practice. During future pandemics, the performed surgical oncology practice during the first wave of the COVID-19 pandemic seems appropriate for short-term results.

Healthcare professional experiences of making surgical oncology decisions and delivering COVID-19 safe care: a qualitative study.

BACKGROUND: The COVID-19 pandemic was declared a public health emergency in March 2020. The British National Health Service (NHS) redirected medical attention towards prioritising COVID-19-positive patients in favour of less urgent care affecting cancer service provision. This study aims to explore experiences of healthcare professionals (HCPs) and investigate the impact of COVID-19 on decision-making in surgical oncology. METHODS: HCPs with experience in surgical oncology were recruited from January 2021 to June 2021. Qualitative semi-structured telephone interviews were conducted and transcribed verbatim. Interviews were conducted until data saturation. Thematic analysis was used to identify frequently discussed themes. RESULTS: A total of 13 participants were interviewed, identifying three main pandemic-related challenges: multi-disciplinary team (MDT) processes - telephone pre-operative assessments impoverished information elicited from in-person examination; service delivery - personal protective equipment (PPE) added complexity to surgical practice and more difficult communication; work routines - increased workload to deliver COVID-safe remote practices and decreased training time. CONCLUSIONS: COVID-19 influenced cancer service provision with teams making significant changes to ensure that effective clinical reasoning and surgical standards were maintained. Managing safe COVID-19 surgical care impacted daily-life and work stressors. Post crisis, service delivery is looking to integrate telemedicine within care whilst reducing its impact on workload and in-practice training.

Will Virtual Care Stand the Test of Time;One Site's Perspective on the Continuity of Virtual Care Post-Pandemic

Introduction: Since the declaration of the COVID-19 pandemic in March 2020, the healthcare field has undergone innumerable changes. Both patients and health care providers (HCP) alike had to adapt to new precautionary measures, while simultaneously addressing ongoing health concerns. Hence, a shift was seen in which many conventional in-person patient appointments were changed into virtual appointments. The aim of this is to analyze patient appointments from March 2019 to February 2022 by the mode in which it was provided. Methods: The total number of visits occurring at Princess Margaret Cancer Center ambulatory thoracic oncology clinic was collected from March 2019 to February 2022. The compiled results were organized by mode of encounter and converted to graph format. The “In-Person” category accounts for traditional patient consults that had been conducted by having patients physically attend the clinic. This includes appointments for new patients and follow-up patient consults for medical, radiation, and surgical oncology. All patient consults that were conducted remotely, where the patient was not physically present within the clinic, are grouped into the “Virtual” category. These appointments were conducted through various media platforms;phone calls, Microsoft Teams, Ontario Telemedicine Network, and telehealth meetings. Results: There is an initial peak in virtual appointments seen at the start of the pandemic, occurring from April 2020 to May 2020. During this time, virtual appointments accounted for more than 65% of appointments. After this, the use of virtual appointments has continued to persist (with virtual appointments accounting for 36% to 50% of consults during the period from June 2020 to February 2022). This occurs despite external changes related to COVID-19, including the introduction of the COVID-19 vaccine, and the fluctuating number of COVID-19 cases. [Formula presented] Conclusions: Although this does not definitively conclude that virtual care will persist after the pandemic has concluded, there is strong evidence to suggest that health care may no longer be limited to in-person settings. With the integration of virtual care, the disadvantages of remote patient care must be considered, primarily the inability to complete a physical assessment. Given these disadvantages, HCP must recognize these limitations and methodically select appropriate situations for utilizing virtual care. There is a growing need to further develop innovative ways to support HCP in providing quality patient care in a virtual platform through research, development, and education. Keywords: COVID-19, Virtual Care