Metastatic spinal compression referral patterns during pandemic lockdowns in Kent region UK

ABSTRACT

Purpose or Objective: Metastatic spinal cord compression (MSCC) is an oncological emergency with a potential for catastrophic neurological deficit. Once diagnosed, MSCC requires urgent treatment to avoid neurological disability. We looked at health-seeking behavioural changes in lockdown 1(L1) (March 23-June 24 2020) compared to the lockdown 2(L2) (Oct 25-Dec 2 2020) in England, UK. This study posited that incidence of MSCC in 2020 especially during L1, would increase due to (i)reduced access to NHS resources due to the pandemic (ii) change in health-seeking behaviour due to perceived risk of COVID-19. (iii) changes to previously accepted practice with regards to systemic and radiotherapy treatment. Modelling studies have shown these factors led to a delay in diagnoses with increased late-stage presentations and cancer-related death. Following the national campaign that ensued due to decline in cancer diagnosis in L1, we hypothesized a reduction in MSCC presentations in L2, due to increased public health awareness and continued availability of cancer services, despite lockdown. Materials and Methods: A retrospective, multicentre analyses of MSCC cases across Kent was undertaken for year 2020. Year 2019 served as control. Study included all MSCC cases across the following NHS trusts (i) Maidstone and Tunbridge Wells (ii) Dartford and Gravesham (iii) East Kent University Hospital and (iv) Medway. Shapiro-Wilk was used to assess normality and unpaired T-test to compare referral numbers between 2019 vs 2020 and between L1 vs L2. p ≤0.05 was considered significant. Results: There were 134 MSCC cases in 2019 vs 193 in 2020. An average of 12 patients per month were treated in 2019 vs 17 in 2020, p=0.002 (fig 1). During L1, the average number of patients was 16 per month vs 11 in 2019 in the same period, p=0.08. For L2, it was 19 vs 11 respectively, p=0.10 (fig 2). More patients were offered single 8Gy fraction treatment in 2020 [77% (n=149) vs 66% (n=89)] (fig 2). (Figure Presented) Conclusion: There was an increase in the total number of MSCC in 2020 and in the average cases per month during lockdowns. This was expected given recent data showing delay in cancer diagnoses with an increase in late presentations. Though the number of MSCC was higher in L2 vs L1, there was a downward trend towards the end of L2. This may signify the positive impact of the national cancer campaign. Unfortunately, Kent region was badly hit with the new Covid 19 strain (B117) and most of the services were affected due to staff redeployment, sickness and isolation. Many patients with existing comorbidities are still anxious utilising hospital services due to perceived infection risk. Further work will be needed to reverse health-seeking behaviours to pre-pandemic levels. Focused cancer public health campaign may be required to allay patient fears and ensure safety, during use of vital health services. More single 8Gy fractions were delivered in 2020 compared to any previous years, indicating MSCC patients may now be scanned, planned and treated in one visit.