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.
- 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."