Pancreas cancer trials for early stage disease: Surgeons leading therapeutic cooperative group trials.

Surgeon-led clinical trials have defined the standard of care for locoregional pancreatic cancer to date. The infrastructure and collaborative nature of cooperative oncology groups offer many advantages, such as providing an ideal mechanism through which multidisciplinary pancreatic cancer trials are performed. As key members of the treatment team, surgeons bring experience and expertise to the design of surgical and multidisciplinary trials and are uniquely poised to be leaders of future pancreatic cancer trials.

Impact of nationwide centralization of oesophageal, gastric, and pancreatic surgery on travel distance and experienced burden in the Netherlands.

BACKGROUND: This study aims to assess the impact of nationwide centralization of surgery on travel distance and travel burden among patients with oesophageal, gastric, and pancreatic cancer according to age in the Netherlands. As centralization of care increases to improve postoperative outcomes, travel distance and experienced burden might increase. MATERIALS AND METHODS: All patients who underwent surgery between 2006 and 2017 for oesophageal, gastric and pancreatic cancer in the Netherlands were included. Travel distance between patient's home address and hospital of surgery in kilometres was calculated. Questionnaires were used to assess experienced travel burden in a subpopulation (n = 239). Multivariable ordinal logistic regression models were constructed to identify predictors for longer travel distance. RESULTS: Over 23,838 patients were included, in whom median travel distance for surgical care increased for oesophageal cancer (n = 9217) from 18 to 28 km, for gastric cancer (n = 6743) from 9 to 26 km, and for pancreatic cancer (n = 7878) from 18 to 25 km (all p < 0.0001). Multivariable analyses showed an increase in travel distance for all cancer types over time. In general, patients experienced a physical and social burden, and higher financial costs, due to traveling extra kilometres. Patients aged >70 years travelled less often independently (56% versus 68%), as compared to patients aged ≤70 years. CONCLUSION: With nationwide centralization, travel distance increased for patients undergoing oesophageal, gastric, and pancreatic cancer surgery. Younger patients travelled longer distances and experienced a lower travel burden, as compared to elderly patients. Nevertheless, on a global scale, travel distances in the Netherlands remain limited.

Redistribution of Outpatient Oncologic Surgical Specialty Referrals During COVID-19.

BACKGROUND: Initial reports of significantly worse outcomes for cancer patients with COVID-19 led to guidelines for triaging surgical cancer treatment. We sought to evaluate the effects of the COVID-19 pandemic on oncologic surgical specialty referrals. METHODS: We compared referrals to oncologic surgical specialty clinics at an academic tertiary care institution following implementation of stay-at-home orders in California (3/19/20-7/31/20, "COVID") to the same time period the year prior (3/19/19-7/31/19, "Pre-COVID"). The number of appointments, consulted surgical services, insurance types, acuity of diagnoses, and times from referral to first appointment (TRFA) were assessed. RESULTS: The overall number of patients seen in matched time periods decreased by 21.6% from 900 (pre-COVID) to 705 (COVID). Proportions of patients with malignant and suspicious diagnoses, surgical and thoracic oncology visits, and Medicaid insurance differed from comparison groups during the COVID period (P < .05). Overall median (interquartile range) TRFA decreased from 14 (20) to 12 (19) days (P = .001) during COVID. CONCLUSION: After implementation of stay-at-home orders, higher acuity and vulnerable patients were appropriately seen in oncologic surgical specialty clinics. While the long-term effects of decreased clinic visits during COVID remain uncertain, further examination of scheduling practices that led to shorter referral times may identify methods to improve timeliness of care and surgical oncologic outcomes in non-pandemic settings.

Radiofrequency Identification Track for Tray Optimization: An Instrument Utilization Pilot Study in Surgical Oncology.

BACKGROUND: Surgical instrument tray reduction attempts to minimize intraoperative inefficiency and processing costs. Previous reduction methods relied on trained observers manually recording instrument use (i.e. human ethnography), and surgeon and/or staff recall, which are imprecise and inherently limited. We aimed to determine the feasibility of radiofrequency identification (RFID)-based intraoperative instrument tracking as an effective means of instrument reduction. METHODS: Instrument trays were tagged with unique RFID tags. A RFID reader tracked instruments passing near RFID antennas during 15 breast operations performed by a single surgeon; ethnography was performed concurrently. Instruments without recorded use were eliminated, and 10 additional cases were performed utilizing the reduced tray. Logistic regression was used to estimate odds of instrument use across cases. Cohen's Kappa estimated agreement between RFID and ethnography. RESULTS: Over 15 cases, 37 unique instruments were used (median 23 instruments/case). A mean 0.64 (median = 0, range = 0-3) new instruments were added per case; odds of instrument use did not change between cases (OR = 1.02, 95%CI 1.00-1.05). Over 15 cases, all instruments marked as used by ethnography were recorded by RFID tracking; 7 RFID-tracked instruments were never recorded by ethnography. Tray size was reduced 40%. None of the 25 eliminated instruments were required in 10 subsequent cases. Cohen's Kappa comparing RFID data and ethnography over all cases was 0.82 (95%CI 0.79-0.86), indicating near perfect agreement between methodologies. CONCLUSIONS: Intraoperative RFID instrument tracking is a feasible, data-driven method for surgical tray reduction. Overall, RFID tracking represents a scalable, systematic, and efficient method of optimizing instrument supply across procedures.

The Development of a Surgical Oncology Center During the COVID-19 Pandemic.

ABSTRACT: Coronavirus disease 2019 (COVID-19) was declared a pandemic by the World Health Organization on March 11, 2020. By mid-March, London had emerged as the epicenter in the United Kingdom, accounting for 45% of the COVID-19-related mortality. A cancer COVID-19-free "cold hub," through National Health Service partnership with independent institutions, was established to maintain a throughput of surgical oncology patients with an accessible triage system for oncologic specialties. The high population density, commuter volume, and rising COVID-19 incidence heightened the challenge of segregating a vulnerable population that was already at high risk for surgical morbidity and mortality.The aim of this review is to report the experience of developing a multicenter COVID-19-free cold hub with the aim of providing safe surgery for surgical oncology patients. We discuss the timeline, structure, and infection control policy and suggest practical points that may guide other health care systems.The surgical oncology hub treated 1542 patients between March 1 and July 1, 2020. There were no cases of COVID-19-related mortality in a 30-day follow-up. Key strategies for the restructuring of the cancer service included the following: (1) formation of an accessible referral pathway, (2) creation and structuring of cold hub hospitals, (3) development of protocols for infection control and preoperative testing, (4) rapid reorganization of services based on initial feedback, and (5) clear communication and leadership.It has been shown that a surgical oncology cold hub with an accessible referral system and an effective system of preoperative screening system can minimize COVID-19 transmission, morbidity, and mortality, in a region with heavy disease prevalence. This structure represents a safe, ethical, and viable system that can be replicated in other health care systems.

Program and candidate experience with virtual interviews for the 2020 Complex General Surgical Oncology interview season during the COVID pandemic.

BACKGROUND: The COVID crisis hit during the interview season for the Complex General Surgical Oncology (CGSO) fellowship. With minimal time to adapt, all programs transitioned to virtual interviews. Here we describe the experience of both program directors (PDs) and candidates with virtual interviews, and provide guidelines for implementation based on the results. METHODS: Surveys regarding interview day specifics and perceptions were created for CGSO fellowship PDs and candidates. They were distributed at the conclusion of the season, prior to match. RESULTS: Thirty (94%) PDs and 64 (79%) candidates responded. Eighty-three% of PDs and 79% of candidates agreed or strongly agreed that they felt comfortable creating a rank list. If given the choice, 60% of PDs and 45% of candidates would choose virtual interviews over in-person interviews. The majority of candidates found PD overviews, fellows only sessions and pre-interview materials helpful. CONCLUSION: Overall, the majority of PDs and candidates felt comfortable creating a rank list; however, more PDs preferred virtual interviews for the future. Our results also confirm key components of a virtual interview day.

Maintaining surgical care delivery during the COVID-19 pandemic: A comparative cohort study at a tertiary gynecological cancer centre.

BACKGROUND: Surgery is the cornerstone of gynecological cancer management, but inpatient treatment may expose both patients and healthcare staff to COVID-19 infections. Plans to mitigate the impact of the COVID-19 pandemic have been implemented widely, but few studies have evaluated the effectiveness of these plans in maintaining safe surgical care delivery. AIM: To evaluate the effects of mitigating plans implemented on the delivery of gynecological cancer surgery during the COVID-19 pandemic. METHODS: A comparative cohort study of patients treated in a high-volume tertiary gyneoncological centre in the United Kingdom. Prospectively-recorded consecutive operations performed and early peri-operative outcomes during the same calendar periods (January-August) in 2019 and 2020 were compared. RESULTS: In total, 585 operations were performed (296 in 2019; 289 in 2020). There was no significant difference in patient demographics. Types of surgery performed were different (p = 0.034), with fewer cytoreductive surgeries for ovarian cancer and laparoscopic procedures (p = 0.002) in 2020. There was no difference in intra-operative complication rates, critical care admission rates or length of stay. One patient had confirmed COVID-19 infection (0.4%). The 30-day post-operative complication rates were significantly higher in 2020 than in 2019 (58 [20.1%] versus 32 [10.8%]; p = 0.002) for both minor and major complications. This increase, primarily from March 2020 onwards, coincided with the first peak of the COVID-19 pandemic in the UK. CONCLUSIONS: Maintaining surgical throughput with meticulous and timely planning is feasible during the COVID-19 pandemic but this was associated with an increase in post-operative complications due to a multitude of reasons.

Recommendations on intervention for hepatobiliary oncological surgery during the COVID-19 pandemic. / Recomendaciones de actuación en cirugía oncológica hepatobiliopancreática durante la pandemia COVID-19.

The SARS-CoV-2 (COVID-19) pandemic requires an analysis in the field of oncological surgery, both on the risk of infection, with very relevant clinical consequences, and on the need to generate plans to minimize the impact on possible restrictions on health resources. The AEC is making a proposal for the management of patients with hepatopancreatobiliary (HPB) malignancies in the different pandemic scenarios in order to offer the maximum benefit to patients, minimising the risks of COVID-19 infection, and optimising the healthcare resources available at any time. This requires the coordination of the different treatment options between the departments involved in the management of these patients: medical oncology, radiotherapy oncology, surgery, anaesthesia, radiology, endoscopy department and intensive care. The goal is offer effective treatments, adapted to the available resources, without compromising patients and healthcare professionals safety.

Impact of the initial phase of COVID-19 pandemic on surgical oncology services at a tertiary care center in Eastern India.

BACKGROUND: The COVID-19 pandemic has caused a global health emergency and affected the resources in both the public and private health sectors significantly. The present study aims to assess the impact of the pandemic on the services by the department in the first 3 months since the first COVID case in the region. METHODS: The study period was from 16 March to 15 June 2020. We queried the database for data on site of the tumor, diagnosis, stage, tumor board decisions and planning, surgical procedures, adjuvant treatment, and follow-up details. The change in tumor board decision and actual treatment taken by the patient were all recorded, taking into consideration the COVID-19 pandemic. RESULTS: Among the 1567 patient contacts, 1306 were out-patient visits and 261 teleconsultations. Fifty-four patients underwent surgery from the 87 admitted to the hospital. Ten preoperative patients and two postoperative patients were tested for COVID and reported to be negative. CONCLUSIONS: The dilemma of providing cancer surgery services to the patients in this pandemic has been global. Strict measures and guidelines can help to overcome the COVID pandemic time, keeping in mind the locoregional logistics.

The American College of Surgeons Response to the COVID-19 Pandemic (Part I): Cancer Care, COVID-19 Registry, Surgeon Wellness.

From the onset of the COVID-19 global pandemic of 2020, the American College of Surgeons has been a leader in disseminating reliable information on the nature of the crisis and assuring quality of surgical care during the enforced lockdown of inpatient and outpatient care.

Preparedness of the cancer hospitals and changes in oncosurgical practices during COVID-19 pandemic in India: A cross-sectional study.

BACKGROUND AND OBJECTIVES: Coronavirus disease-2019 (COVID-19) pandemic has impacted cancer care across India. This study aimed to assess (a) organizational preparedness of hospitals (establishment of screening clinics, COVID-19 wards/committees/intensive care units [ICUs]/operating rooms [ORs]), (b) type of major/minor surgeries performed, and (c) employee well-being (determined by salary deductions, paid leave provisions, and work in-rotation). METHODS: This online questionnaire-based cross-sectional study was distributed to 480 oncosurgeons across India. We used χ2 statistics to compare responses across geographical areas (COVID-19 lockdown zones and city tiers) and type of organization (government/private, academic/nonacademic, and dedicated/multispecialty hospitals). P < .05 was considered significant. RESULTS: Total of 256 (53.3%) oncologists completed the survey. About 206 hospitals in 85 cities had screening clinics (98.1%), COVID-19 dedicated committees (73.7%), ward (67.3%), ICU's (49%), and OR's (36%). Such preparedness was higher in tier-1 cities, government, academic, and multispecialty hospitals. Dedicated cancer institutes continued major surgeries in all oncological subspecialties particularly in head and neck (P = .006) and colorectal oncology (P = .04). Employee well-being was better in government hospitals. CONCLUSION: Hospitals have implemented strategies to continue cancer care. Despite limited resources, the significant risk associated and financial setbacks amidst nationwide lockdown, oncosurgeons are striving to prioritize and balance the oncologic needs and safety concerns of cancer patients across the country.

Neuro-oncology Multidisciplinary Clinic and Improvements in Patient Outcome.

BACKGROUND: Neuro-oncology care is becoming increasingly complex and patients often see multiple specialists. Multidisciplinary clinic (MDC) is a patient-centric option to allow multiple specialists to be involved where patients see multiple providers on the same day. OBJECTIVE: The objective of this study was to evaluate the role of a neuro-oncology MDC on patient outcomes. MATERIALS AND METHODS: Retrospective study was performed on consecutive patients who received radiosurgery for central nervous system (CNS) disease. We evaluated patients 2 years before and 2 years after the implementation of a MDC. RESULTS: A total of 351 patients were analyzed, 163 patients before MDC and 188 after implementation of MDC. Before MDC the median follow-up was dependent on which department ordered follow-up radiographic imaging. This discrepancy decreased after the MDC. Overall survival for patients with CNS metastatic disease improved in the MDC cohort (median survival of 248 before MDC and 315 d after, P<0.027). CONCLUSION: We found that neuro-oncology MDC improved follow-up across disciplines and improved overall survival for patients with CNS metastatic disease.

Caring for cancer patients in the Covid pandemic: choosing between the devil and deep sea.

BACKGROUND: Healthcare is an essential service at any time more so in the crisis like Covid. With increase in number of cases and mortality from Covid, the primary focus is shifted to the management of the Covid crisis and other health emergencies thus affecting normal health services and routine treatment of other diseases like cancer. METHODS: This article reviews the published literature and guidelines on Covid and cancer and discusses them to optimize the care of cancer patients during Covid pandemic to improve treatment outcomes. RESULTS: The results of the review of published literature show a twofold increase in probability of getting CoV2 infection by the cancer patients and a four-fold increase in chance of death. On the other hand, if left untreated a 20% increase in cancer death is expected. Data further show that none of the medicines like remdesivir, hydroxy chloroquin, dexamethasone, or azithromycin improves survival and response to Covid in cancer patients. Surgical results too show similar outcome before and after the pandemic though most of these report on highly selected patients populations. CONCLUSIONS: The Covid 2019 pandemic places cancer patients in a very difficult situation wherein if they seek treatment, they are exposing themselves to a risk of developing CoV2 infection and if they do not, the probability of dying without treatment increases. Hence, for them it is a choice between the devil and deep sea, and it is for the healthcare providers to triage patients and treat who cannot wait even though the data from the carefully selected cohort of patients show no increase in mortality or morbidity from treatment during Covid.

Recommendations for head and neck surgical oncology practice in a setting of acute severe resource constraint during the COVID-19 pandemic: an international consensus.

The speed and scale of the global COVID-19 pandemic has resulted in unprecedented pressures on health services worldwide, requiring new methods of service delivery during the health crisis. In the setting of severe resource constraint and high risk of infection to patients and clinicians, there is an urgent need to identify consensus statements on head and neck surgical oncology practice. We completed a modified Delphi consensus process of three rounds with 40 international experts in head and neck cancer surgical, radiation, and medical oncology, representing 35 international professional societies and national clinical trial groups. Endorsed by 39 societies and professional bodies, these consensus practice recommendations aim to decrease inconsistency of practice, reduce uncertainty in care, and provide reassurance for clinicians worldwide for head and neck surgical oncology in the context of the COVID-19 pandemic and in the setting of acute severe resource constraint and high risk of infection to patients and staff.

Head and neck oncologic surgery in the COVID-19 pandemic: Our experience in a deep south tertiary care center.

INTRODUCTION: The ongoing worldwide pandemic due to COVID-19 has forced drastic changes on the daily lives of the global population. This is most notable within the health care sector. The current paper outlines the response of the head and neck oncologic surgery (HNS) division within our academic otolaryngology department in the state of Alabama. METHODS: Data with regard to case numbers and types were obtained during the pandemic and compared with time matched data. Our overall approach to managing previously scheduled and new cases, personal protective equipment (PPE) utilization, outpatient clinic, and resident involvement is summarized. DISCUSSION: Our HNS division saw a 55% reduction in surgical volume during the peak of the COVID-19 pandemic. We feel that an early and cohesive strategy to triaging surgical cases, PPE usage, and minimizing exposure of personnel is essential to providing care for HNS patients during this pandemic.

Coronavirus (COVID-19): Patient experience-Administrative services on the frontline during crisis.

The COVID-19 pandemic has had a dramatic impact on care delivery among health care institutions and providers in the United States. As a categorical cancer center, MD Anderson has prioritized care for our patients based on acuity of their disease. We continue to implement measures to protect patients and employees from acquiring the infection within our facilities, and to provide acute management of cancer patients with concomitant COVID-19 infections who are considered at high risk of death. The Division of Patient Experience, formerly established in October 2016, has played an integral role in the institution's pandemic response from its inception. The team actively supported programs and processes in anticipation of the pandemic's effect on our patients and employees. We will describe how the team continues to serve in the ever-dynamic environment as we approach the expected surge in COVID-19 cases among our patient population, our employees, and in our community.

Pandemic Recovery Using a COVID-Minimal Cancer Surgery Pathway.

The coronavirus disease 2019 (COVID-19) pandemic has created unprecedented disruption in health care delivery around the world. In an effort to prevent hospital-acquired COVID-19 infections, most hospitals have severely curtailed elective surgery, performing only surgeries if the patient's survival or permanent function would be compromised by a delay in surgery. As hospitals emerge from the pandemic, it will be necessary to progressively increase surgical activity at a time when hospitals continue to care for COVID-19 patients. In an attempt to mitigate the risk of nosocomial infection, we have created a patient care pathway designed to minimize risk of exposure of patients coming into the hospital for scheduled procedures. The COVID-minimal surgery pathway is a predetermined patient flow, which dictates the locations, personnel, and materials that come in contact with our cancer surgery population, designed to minimize risk for virus transmission. We outline the approach that allowed a large academic medical center to create a COVID-minimal cancer surgery pathway within 7 days of initiating discussions. Although the pathway represents a combination of recommended practices, there are no data to support its efficacy. We share the pathway concept and our experience so that others wishing to similarly align staff and resources toward the protection of patients may have an easier time navigating the process.