Cookies on this website
We use cookies to ensure that we give you the best experience on our website. If you click 'Continue' we'll assume that you are happy to receive all cookies and you won't see this message again. Click 'Find out more' for information on how to change your cookie settings.

Sarcoma cancer in Oxford was reorganised during the pandemic. Two studies reveal their success and serve as a guide to other units facing the similar challenge of supporting patients.

Virtual consultation with doctor © Shutterstock
The Oxford Sarcoma Service introduced virtual consultations with patients during the pandemic

During the COVID-19 pandemic, unprecedented strain was placed on healthcare systems across the globe. Many patients saw elective surgeries and non-urgent appointments cancelled but essential services like cancer needed to continue to prevent disease progression and reduce mortality.

The Oxford Sarcoma Service at the Nuffield Orthopaedic Centre (one of five nationally approved centres in England for the treatment of rare bone tumours and sarcomas) saw itself urgently needing to reorganise its structure of cancer care.

To ensure continuation of its services whilst minimising transmission among its patients the Oxford Sarcoma Service was re-structured based on the guidelines issued by the National Health Service (NHS) and the British Orthopaedic Oncology Society (BOOS).

A number of changes were implemented without compromising on delivery of a high standard of care to patients, and its experiences have been published in The Journal of Clinical Orthopaedics and Trauma to serve as a guide to similar units managing bone and soft tissue tumours.

Key changes

  • Virtual multidisciplinary team (MDT) meetings: Key enablers i.e. radiologists, pathologists, orthopaedic oncologists and administrative co-ordinators still meet in person with increased interpersonal spacing while other specialists dial in.
  • Avoiding unproductive attendances at hospital: The service triaged patients to an appropriate referral pathway to bring forward urgent intervention and only patients with active disease which warranted urgent surgery were brought to clinics.
  • Telephone or Video consultations, especially for follow-up patients: Surgery was scheduled only on patients on Level 1a/1b and Level 2 priority. Follow up patients, and patients with benign disease, had telephone/video consultations.
  • Use of COVID-free hospital for surgery: A non-public hospital was used to manage COVID-negative cases. All patients had pre-operative screening for COVID-19, no attenders were allowed, and level 2 PPE was employed by the entire surgical team.
  • Intentional postponement of adjuvant therapies for stable cancers: Adjuvant chemotherapy or radiation therapy were postponed for patients with stable cancer to reduce frequency of trips to hospitals where there was increased risk of disease contraction.

This reorganisation, and a tailored approach to patient treatment, meant the Oxford Sarcoma Service was able to provide uninterrupted care to patients and those most in need of surgery were able to go ahead with their operation.

Surgery was performed on 56 patients with bone and soft tissue traumas during the first two months of the pandemic, either in a COVID-free facility or at the reorganised NOC.

Patient outcomes were monitored and the results published in International Orthopaedics 

The majority of patients were recovering well 30 days after their surgery (96.4%), despite some seeing post-operative complications (7.1%). Four patients contracted COVID-19 of which three required escalation of care and two died (3.6%). Patients under 60 years old had significantly fewer complications than those over 60, and patients operated on in the COVID-free facility had fewer complications than those operated on in the index hospital.

"Surgery on cancer patients during the pandemic is associated with risks and if there was a second wave of COVID-19, serious consideration should be given to ways of protecting vulnerable patients," said Raja Bhaskara Rajasekaran, lead author of the studies. "Our approach to restructuring our services and using either COVID-free facilities or delaying treatment where possible could be a valuable lesson to similar cancer services across the world."

 

Similar stories

New guidelines to improve reporting standards of studies that investigate causal mechanisms

Researchers at NDORMS have developed a new set of guidelines for reporting mediation analyses in health research.

New Associate Professors announced at NDORMS

The Medical Sciences Division has awarded the title of Associate Professor to five senior researchers at NDORMS.

COVID-19 vaccines shown to reduce infection by 90% in nursing homes

A new collaborative study between the Catalan Institute of Health, the Public Health Secreatariat of Catalonia, and the Centre for Statistics in Medicine, NDORMS, at the University of Oxford have confirmed that COVID-19 vaccines greatly reduce infections, hospitalisations and mortality for up to 6 months.

The Kennedy Institute completes its roof extension

Building work at the Kennedy Institute of Rheumatology has finished, providing a new third floor that houses additional meeting and collaboration space for data science and offices for the management of clinical trials.

Unlocking the secrets of the microbiome

Jethro Johnson, Deputy Director of the Oxford Centre for Microbiome Research explains how the centre is building a research community to understand the microbiome and harness its power to promote health and prevent disease.

Into the future: watching biology unfold

As part of the University of Oxford’s mission to provide its researchers with the newest state-of-the-art optical imaging equipment and as part of a strategic partnership with the Kennedy Institute of Rheumatology (KIR), the Institute of Developmental and Regenerative Medicine (IDRM), and Carl Zeiss AG (ZEISS), ZEISS has installed a ZEISS Lattice Lightsheet 7 microscope at the KIR.