Delivering safe and timely cancer care during COVID‐19: lessons and successes from the transition period

Abstract

The pandemic caused by COVID-19 has caused significant strain on healthcare professionals across the globe. Without downplaying the devastating effects of the virus itself, the collateral damage, specifically in cancer care, has only compounded an already difficult time in medicine [1]. Previously protected by cancer treatment targets, cancer patients across the country found their care halted by coronavirus as hospitals cancelled elective clinics and operating lists to redeploy staff. Resources aside, a second challenge for those that continued with services was how to minimize the patient’s risk of spreading or contracting coronavirus. Almost half of patients with concurrent COVID-19 infection experienced postoperative pulmonary complications, and so it is imperative that we shield our patients as best as we can [2]. At the Royal Surrey NHS Foundation Trust, we implemented a number of steps to ensure both the safety of our patients and the care of our cancer patients in a difficult time. After the lifting of the first lockdown we registered the present audit to critique our outcomes in pelvic oncology in accordance with local governance protocols. Our renal cancer patients are referred to a local tertiary centre and therefore were not included in this audit. Like other centres, we utilized a local private hospital in order to deliver our elective surgical service. We acknowledge, however, that a key factor in our favour was the proximity of our local private Nuffield hospital (GN), which is directly connected to the primary trust day-case operating theatres. From 6 April 2020, at the beginning of the pandemic, two Xi Da Vinci robots were relocated to GN which was to be used as a ‘COVID-19-clean’ site at which to deliver elective robotic surgery, alongside other procedures. Staff to patient transmission was an acute concern throughout. To combat this, non-surgeon staff were divided between the two sites, with those working at GN having a weekly PCR swab test. Results were available within 48–72 h. All theatre staff were dedicated to GN and did not work at the main hospital. Surgeons' work was divided, with a weekly alternating pattern of working at GN or at the main hospital site. All surgeons were also swabbed weekly on Fridays in preparation for their week at the ‘COVID-19-clean’ GN site. None of our staff members received positive swab results during this time. All outpatient care was diverted to telephone consultations as of 23 March 2020. For those that required clinical examination or flexible cystoscopy, face-to-face review remained available, with staff wearing standard personal protective equipment (PPE). Patients attending appointments were advised to wait in their car before being contacted to attend the appointment, to reduce numbers in the department. Patients completed COVID-19 screening questionnaires by telephone prior to attending, as well as a questionnaire on arrival. Face-to-face outpatient care took place in the urology centre, which has a separate entrance to the main hospital. National guidelines were followed for patients, such as COVID-19 symptom screening (by telephone and on arrival), two-week isolation, and preoperative nasopharyngeal swabs within 72 h of surgery [3]. On admission each patient had a separate side room. Both morning and afternoon surgery patients were admitted at 08:00 h. No holding bay in theatre was used and patients were wheeled directly into theatre for their anaesthetic. As per Public Health England COVID-19 infection control policy, minimal staff numbers were present in theatre and all theatre staff wore PPE for the duration of each procedure. Where appropriate, an airseal port confined carbon dioxide plume. As a tertiary robotic centre, our enhanced recovery pathway is well established and, where possible, we continued to adhere to it. Patients undergoing robot-assisted radical cystectomy undertook prehabilitation to optimize cardiorespiratory function. Patients were optimize