To avoid delay in oncological treatment, a 6-weeks norm for time to treatment has been agreed on in The Netherlands. However, the impact of the COVID-19 pandemic on health systems resulted in reduced capacity for regular surgical care. In this study, we investigated the impact of the COVID-19 pandemic on time to treatment in surgical oncology in The Netherlands. Methods: A population-based analysis of data derived from five surgical audits, including patients who underwent surgery for lung cancer, colorectal cancer, upper gastro-intestinal, and hepato-pancreato-biliary (HPB) malignancies, was performed. The COVID-19 cohort of 2020 was compared to the historic cohorts of 2018 and 2019. Primary endpoints were time to treatment initiation and the proportion of patients whose treatment started within 6 weeks. The secondary objective was to evaluate the differences in characteristics and tumour stage distribution between patients treated before and during the COVID-19 pandemic. Results: A total of 14,567 surgical cancer patients were included in this study, of these 3292 treatments were started during the COVID-19 pandemic. The median time to treatment decreased during the pandemic (26 vs. 27 days,p< 0.001) and the proportion of patients whose treatment started within 6 weeks increased (76% vs. 73%,p< 0.001). In a multivariate logistic regression analysis, adjusting for patient characteristics, no significant difference in post-operative outcomes between patients who started treatment before or after 6 weeks was found. Overall, the number of procedures performed per week decreased by 8.1% during the pandemic. This reduction was most profound for patients with stage I lung carcinoma and colorectal carcinoma. There were fewer patients with pulmonary comorbidities in the pandemic cohort (11% vs. 13%,p= 0.003). Conclusions: Despite pressure on the capacity of the healthcare system during the COVID-19 pandemic, a larger proportion of surgical oncological patients started treatment within six weeks, possibly due to prioritisation of cancer care and reductions in elective procedures. However, during the pandemic, a decrease in the number of surgical oncological procedures performed in The Netherlands was observed, especially for patients with stage I disease.
为避免肿瘤治疗延误，荷兰已就治疗启动时间达成六周标准。然而，COVID-19大流行对医疗系统的影响导致常规手术诊疗能力下降。本研究旨在探讨COVID-19大流行对荷兰肿瘤外科治疗启动时间的影响。方法：基于五项外科审计数据进行人群分析，纳入接受肺癌、结直肠癌、上消化道癌及肝胰胆恶性肿瘤手术的患者。将2020年COVID-19队列与2018-2019年历史队列进行比较。主要终点为治疗启动时间及六周内启动治疗的患者比例。次要目标是评估疫情前后患者特征与肿瘤分期分布的差异。结果：本研究共纳入14,567例外科肿瘤患者，其中3,292例在疫情期间启动治疗。疫情期间治疗中位时间缩短（26天 vs 27天，p<0.001），六周内启动治疗的患者比例增加（76% vs 73%，p<0.001）。经多变量逻辑回归分析校正患者特征后，六周前后启动治疗患者的术后结局无显著差异。疫情期间每周手术总量下降8.1%，其中Ⅰ期肺癌和结直肠癌患者降幅最为显著。疫情队列中合并肺部疾病患者比例更低（11% vs 13%，p=0.003）。结论：尽管COVID-19大流行期间医疗系统承压，但肿瘤外科患者六周内启动治疗的比例反而上升，这可能源于肿瘤诊疗优先政策及择期手术的缩减。然而疫情期间荷兰肿瘤外科手术总量出现下降，尤以Ⅰ期疾病患者为著。
肿瘤(癌症)患者之家