Surgical Backlog; a Nuanced Cancer Perspective
References
Jonathan Wang, Saba Vahid, Maria Eberg, et al. Clearing the surgical backlog caused by COVID-19 in Ontario: a time series modelling study. CMAJ 2020;10.1503/cmaj.201521.
https://www.theglobeandmail.com/canada/article-ontario-appoints-jane-philpott-to-lead-pandemic-data-effort/
https://www.cdc.gov/mmwr/volumes/69/wr/mm6923e1.htm
Wang et al provide an opportune modeling study estimating an 84 week surgical backlog recovery in Ontario.1 We would like to highlight some nuances in the data that pertain particularly to cancer patients and it’s recovery plan implications.
Data on cancer-directed surgeries remain incomplete, as acknowledged by the authors. To date, the most complete records arise from the Discharge Abstract and Same Day Surgery Databases both from the Canadian Institute of Health Information, for which there is a lag.2 Nonetheless, even revisions to model input with real-world complete data are likely to demonstrate a significant backlog.
Estimates of the cancer surgical backlog is far more complex than the presented model. Provincial screening programs, diagnostic imaging and procedures were all nearly shut down during the early pandemic months, now with their own backlog. Access to primary care was at an all time low. In some jurisdictions the emergency department was used 42% less during COVID than similar historical time periods which is associated at least in part with patients fear of presenting to hospitals.3 These factors have led to delays in diagnosis, stage migration, and potential a drop in surgical wait lists given some patients are no longer resectable.
These potential lives lost require further study and may lead to a major disruption in cancer survival outcomes for years to come. We therefore strongly agree with the retort by Wang et al that a coordinated increase in resources and surgical prioritization is required to mitigate these risks urgently.