Optimal cancer care pathways - The ideal versus reality for patient centric cancer care during COVID19

ABSTRACT

Purpose: Cancer management is time sensitive with documented increased mortality with delays from diagnosis to treatment (1-4). National and international 'optimal care paths' and Cancer plans have been established to ensure patient centric, standardised approaches to cancer care based on best available evidence (5-7). Australian, Victorian Cancer Council-Optimal Care Pathways is a nationally endorsed guideline (5). However, there are limited publications assessing actual performance of cancer services against set guidelines (8). There are known barriers to achieving optimal cancer care with these likely amplified by the COVID19 pandemic (9-10), with these delays impacting on disease control, quality of life and significant economic costs (11-14). We aimed to assess performance against optimal care path guidelines and the potential impact of the COVID19 pandemic on achieving this ideal. Methods and Materials Patients undergoing curative treatment with radiotherapy in Head and Neck (HN), Breast, Lung and Gastrointestinal malignancies between 2019-2021 in a single institution were included. Performance against the Victorian Cancer Council Guidelines for commencement of Radiotherapy in the definitive and neo/ adjuvant settings were analysed using the one sample t-test. The impact of COVID19 was analysed using a Mann Whitney U Test. Result(s) 733 patients between 2019-2021 were included in the retrospective analysis. Guidelines were only met by 65% breast (p = 0.2606), 35% HN-adjuvant (p =0.0000), 37% HN-definitive (p=0.6059), 74% Lung (p=0.3725), 4% oesophagus (p = 0.0002) and 33% rectal (p=0.0022) cancer patients. Percentage of patients exceeding guidelines by more than half the recommended time was 4% breast, 27% HN-adjuvant, 19% HN-definitive, 10% Lung, 76% oesophagus and 50% rectal cancer patients. There was no detrimental impact of COVID19 on guideline compliance between all tumour sites (p<0.05). Conclusion(s) This limited retrospective study highlights the persistent challenges in achieving optimal cancer care pathways designed to ensure quality care and best possible outcomes for patients. Further investigation will be done to identify the compliance across the comprehensive multi-disciplinary care path, barriers to achieving the optimal and potential solutions at a local level. However, a national strategy is required in strengthening the evidence base for the care paths, identifying the actual compliance of Cancer Services with defined 'optimal' guidelines, the barriers to achieving these and the potential qualitative/quantitative impact of not achieving 'optimal guidelines' on patients, society and the health care systems.