The effect of the first wave of the COVID-19 pandemic on surgical oncology case volumes and wait times

ABSTRACT

Background: There are well-established provincial guidelines surrounding target wait times for patients diagnosed with cancer. Wait 1 is the time from initial referral to a patient's first surgical oncology appointment. Wait 2 is the time from the decision to operate to the actual operation. During the first wave of the COVID-19 pandemic in March 2020, elective operations decreased and the majority of in-person appointments were cancelled or changed to telephone appointments. Oncologic operations were allowed to continue;however, routine screening temporarily stopped. The objective of this study is to determine the effect of the COVID-19 pandemic on overall case counts, Wait 1 and Wait 2. Methods: All patients diagnosed with cancer and referred for surgical management at our centre from Mar. 15 to June 30, 2019, were compared with those in the same time period in 2020. Results: In 2020, there was a significant decrease in new cases, from 666 to 588 (p < 0.001). Surgical specialties varied greatly in how much the case volume was affected. When we compared Wait 1 from 2019 to 2020, significantly more patients (p = 0.019) met the target time for Wait 1 in 2020 (89.4%) compared with 2019 (85.0%). However, significantly fewer (p < 0.001) patients met the target time for Wait 2 in 2020 (71.6%) than in 2019 (88.4%). Again, there was variability in the ability to meet target wait times for both Wait 1 and Wait 2 by surgical specialty. The decrease in overall case counts from 2019 to 2020 (11.7%) was less than the provincial decrease in cases (23.2%) over the same time period. Conclusion: While overall case volumes dropped, the decrease was not universal across surgical specialties. Further, the majority of subspecialties improved in Wait 1, while the majority had a lengthening of Wait 2. It remains to be seen whether individual patient outcomes will suffer because of the first wave of the COVID-19 pandemic.