A Multi-Disciplinary Team Approach to managing Cancer Care Delivery during the COVID19 Pandemic

ABSTRACT

Objective: The COVID 19 rapid guideline NG161 delivery of systemic anticancer treatment (SACT) was issued to reduce the risk to patients and manage capacity during the pandemic. With national screening programmes and cancer surgery postponed, SACT treatment was often the only treatment option for many cancer patients. However, workforce and capacity reduction in day units due to social distancing rules and COVID related sickness many day units were unable to cope with demand. Through MDT approach, MVCC was able to maximise and maintain safe delivery of SACT treatment throughout the pandemic. Methods: To maximise safe delivery of SACT treatment, the critical factors identified were environment, workforce, asymptomatic COVID testing, workflow management and SACT treatment protocol review and implementation. In addition to implementation of Covid safety measures and asymptomatic testing of patients and staff, workflow redesign in outpatient, day units and wards was undertaken. This was further bolstered with use of remote consultations and expansion of Non-Medical Prescribing Pharmacist clinics. Implementation of electronic referral system to monitor and prioritise SACT referrals in line with the NG161 guidelines and rapid implementation of the national interim treatment options allowed significant efficiencies in treatment times. To measure the effect of these initiatives, a retrospective analysis of data from local and national cancer waiting times(CWT) along with the Cancerstat COVID dashboard was conducted. Results: The Pre-COVID period is defined as April 2019-February 2020 and March 2020-January 2021 is defined as during COVID. For the CWT31 days wait from a decision-to-treat to first treatment for cancer, there was a significant statistical difference between pre-and during COVID with CI = 198 to 224;p < 0.0497. There were fewer referrals but performance improved during COVID. There was no statistically significant difference in the total number of of patients seen for both one month wait from a decision-to-treat to a subsequent treatment and 2 month wait for GP urgent referral to a first treatment, but a statistically significant improvement in performance with p < 0.002 and p < 0.0005 during COVID better than pre-COVID. From the Cancerstat COVID dashboards, with CI = 1480.6 to 1592.6, p value = 0.114 there is no statistically difference in the number of patients treated pre and during COVID. The measures that the MDT team put in place allowed the cancer centre to deliver the same amount of SACT treatments to cancer patients during COVID. There is a statistically significant difference in the type of SACT treatment delivered pre and during COVID with a significantly higher number of oral and immunotherapy containing SACT regimens delivered. Conclusion: With the measures that the MDT team put in place the cancer centre was able to maintain business as usual and deliver the same volume of SACT treatments during COVID compared to pre-COVID levels. The oncology pharmacy workforce played a critical role within the MDT team and was at the forefront of many of the initiative implemented to counter the workforce and capacity restrictions resulting from the COVID pandemic, can be demonstrated as a crucial role in the multidisciplinary team to make a positive impact to cancer patient care.