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Showing content from https://pubmed.ncbi.nlm.nih.gov/33686679/ below:

The impact of the first peak of the COVID-19 pandemic on colorectal cancer services in England and Wales: A national survey

. 2021 Jul;23(7):1733-1744. doi: 10.1111/codi.15622. Epub 2021 Apr 8. The impact of the first peak of the COVID-19 pandemic on colorectal cancer services in England and Wales: A national survey

Affiliations

¹ London School of Hygiene and Tropical Medicine, London, UK.
² Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.
³ Department of Clinical Oncology, Guy's and St Thomas' NHS Trust, London, UK.
⁴ Department of Oncology, The Christie NHS Foundation Trust, Manchester, UK.
⁵ Department of Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.

PMID: 33686679
PMCID: PMC8250906
DOI: 10.1111/codi.15622

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The impact of the first peak of the COVID-19 pandemic on colorectal cancer services in England and Wales: A national survey

Jemma M Boyle et al. Colorectal Dis. 2021 Jul.

. 2021 Jul;23(7):1733-1744. doi: 10.1111/codi.15622. Epub 2021 Apr 8. Affiliations

¹ London School of Hygiene and Tropical Medicine, London, UK.
² Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.
³ Department of Clinical Oncology, Guy's and St Thomas' NHS Trust, London, UK.
⁴ Department of Oncology, The Christie NHS Foundation Trust, Manchester, UK.
⁵ Department of Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.

PMID: 33686679
PMCID: PMC8250906
DOI: 10.1111/codi.15622

Item in Clipboard

Abstract

Aim: The object of this work was to study how National Health Service hospitals in England and Wales aimed to maintain effective and safe colorectal cancer (CRC) services during the first peak of the COVID-19 pandemic (April 2020).

Method: A national survey was performed among all 148 hospitals providing CRC services. Information was collected about changes in referrals, diagnostic, staging and therapeutic procedures, as well as whether there was access to a 'cold site' (a hospital facility free of COVID-19). Clinicians in each hospital were also asked to give the 'single most important lesson learned' about keeping services safe and effective.

Results: Full responses were received from 123 (83%) hospitals, and information about 'cold sites' was available for 146 (99%). Eighty hospitals (54%) had access to a 'cold site' and this was increased in regions with higher COVID-19 infection rates (p <0.001). Of the 123 responding hospitals, 105 (85%) indicated that referrals of patients with suspected CRC had dropped by at least 30%, and 69 (56%) indicated that treatment plans were altered in at least 50% of CRC patients. However, 'cold site' availability protected the capacity for diagnostic colonoscopy (p = 0.013) and CRC resection (p = 0.010). Many 'lessons learned' highlighted the importance of adequate structural service organization, often mentioning 'cold sites' and regional coordination as examples, good communication and triage of patients based on clinical urgency.

Conclusion: Access to 'cold sites', as well as regional coordination, clear communication and strong leadership, were found to be pivotal in maintaining capacity for diagnosis and treatment of CRC during the COVID-19 surge.

Keywords: COVID-19; cold site; colorectal cancer.

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Conflict of interest statement

There are no conflicts of interest to disclose.

Figures
FIGURE 1

Map of reported ‘cold sites’…

FIGURE 1

Map of reported ‘cold sites’ for colorectal cancer surgery by English region and…

FIGURE 1

Map of reported ‘cold sites’ for colorectal cancer surgery by English region and Wales

FIGURE 2

Cumulative COVID‐19 rate per 100…

FIGURE 2

Cumulative COVID‐19 rate per 100 000 population and access to surgical COVID‐19 ‘cold…

FIGURE 2

Cumulative COVID‐19 rate per 100 000 population and access to surgical COVID‐19 ‘cold site’ by English region and Wales

FIGURE 3

Impacts of the COVID‐19 pandemic…

FIGURE 3

Impacts of the COVID‐19 pandemic on the management of colorectal cancer patients in…

FIGURE 3

Impacts of the COVID‐19 pandemic on the management of colorectal cancer patients in England and Wales

FIGURE 4

The single most important lesson…

FIGURE 4

The single most important lesson about how to make CRC services as safe…

FIGURE 4

The single most important lesson about how to make CRC services as safe and effective as possible for patients during the COVID‐19 pandemic (CNS, clinical nurse specialist; FIT, faecal immunochemical testing; MDT, multidisciplinary team; PPE, personal protective equipment). (Note: FIT involves the detection of abnormal levels of blood within the stool. Patients with a negative FIT and normal haemoglobin with vague symptoms can be reassured that their risk of CRC is very low. In patients with low‐risk symptoms but a positive FIT test, an urgent referral should be completed. FIT is therefore useful as a triage tool to guide the prioritization of investigations if there is limited diagnostic capacity [37, 38])