Cancer care

3 major impacts of COVID-19 on medical oncology teams

The impact of the COVID-19 pandemic on medical oncology departments has been fewer hospital admissions, a transition to telephone-based outpatient clinics and reduced clinical trial activity, experience at a NSW cancer centre suggests.

A review of activity at Calvary Mater Newcastle during the first three months of the pandemic (February to May 2020) showed there was a 21% decrease in inpatient admissions compared to the same period prior in the previous year.

While the greatest impact was seen in April of that year, with a 44% reduction in admissions, there was an overall 22% reduction in the total inpatient days (2842 vs 2203) at the centre which covers a population of almost a million people in NSW.

However there was no change in the average length of stay in hospital (6.4 vs 6.2 day), according to the study led by medical oncologist Dr Avraham Travers, which covered the Newcastle Private Hospital as well as the Calvary Mater Newcastle.

The medical oncology team saw a slight increase in outpatient consultations, including new-patient consultations during the pandemic, but with about a quarter of face-to-face consultations replaced by telephone consultations (4859 in 2019 vs 3623 in 2020),.

There was minimal uptake of telehealth consultations at the hospital (69 in the 2020 period vs 6 in the same pre-COVID-19 period).

The pandemic did not reduce the number of new patient referrals to the cancer centre and there was no change in the Day Treatment Centre activity or in the delivery of chemotherapy, immunotherapy and supportive/adjunct treatments between 2019 and 2020.

The medical oncology team did seem to adapt treatment to risk, with a smaller proportion of new patients being offered active treatment (68% vs 76% pre-COVID). Similarly, a smaller proportion of new patients were planned for palliative treatment (28% vs 35%), while a greater proportion were offered observation alone (23% vs 16%).

No change was seen in the proportion of new patients planned for curative intent, chemoradiotherapy, neoadjuvant or adjuvant treatments.

The onset of the pandemic did have a significant impact on oncology clinical trial activity, with more than a third (36%) put on hold and a 33% reduction in trials with active recruitment. The department say a major drop in new trials starting in 2020 compared to 2019 (5 vs 2), and almost 50% drop in the number of patients consenting  to trial participation (62 vs 34).

The study authors said the hospital’s medical oncology services had adapted rapidly to meet the changing demands of the pandemic, but the decline in admissions may also have been due to external factors such as patients fears of going to hospital because of infection risk and reluctance to seek medical care.

For those patient s who were admitted it seemed they were able to receive similar levels of care and were not necessarily more unwell, they noted.

“Many oncology inpatient admissions are related to a febrile illness, most of which resolve as inter-current viral illness rather than neutropenic sepsis. We speculate that social distancing and improved hygiene implemented to control the spread of COVID-19 led to a decline in these presentations,” they said.

The low uptake of videoconferencing might be due to the lack of digital infrastructure and lack of patient education or acceptance of video consultations, they suggested.

“Anecdotally, several factors contributed to the minimal use of video-based communication including lack of familiarity (both clinician and patient), technical challenges (e.g. insufficient internet speed and connectivity) and specific telehealth workflow challenges compounded by already overbooked clinics with little available time to troubleshoot,” they wrote.

A lack of digital infrastructure and data access was especially detrimental for providing telehealth to regional and rural patients, they added

They said it was also reassuring to note that levels of referrals and treatment remained almost unaffected by the pandemic and contrary to predictions, no substantial shift from i.v. to oral treatment was observed.

“The continuum of care was largely defended despite heightened infection control, resource reallocations and growing service volumes,” they concluded.

However the decline in clinical trial activity was cause for concern, they said, especially as it threatened to cut off patient access to new trials and treatments.

The reduction apparently reflected risk-mitigation by commercial and academic sponsors, and this seemed driven in part by safety and ethical considerations reducing the need for non–standard-of-care visits and investigations, they said.

“The sustainability of clinical trial teams that rely on funding obtained through commercial trial participation has also been threatened and may have flow-on effects on the ability of Australian institutions to undertake clinical trials and support academic endeavours,” they warned.

The findings are published in the Internal Medicine Journal.

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