Slowdown of Cancer Surgeries During Pandemic May Have Impacted Patient Survival: Study

Paramedics wheel a patient into the emergency department at Mount Sinai Hospital in Toronto on Jan. 13, 2021. (The Canadian Prss/Cole Burston)

Many surgeries were postponed to preserve health-care capacity during the COVID-19 pandemic, yet these measures may have resulted in shorter survival rates for cancer patients, a new study shows.

Published March 21 in the Canadian Medical Association Journal, the study evaluates the long-term consequences of pandemic-related cancer surgery slowdowns on cancer survival in Ontario.

“Longer wait times from slowdowns of cancer surgeries during the COVID-19 pandemic are projected to lead to decreased long-term survival for many patients with cancer,” says the study, titled, “Impact of cancer surgery slowdowns on patient survival during the COVID-19 pandemic: a microsimulation modelling study.”

At the start of the pandemic in March 2020, Ontario asked its hospitals to decrease elective surgeries and non-emergent procedures in order to “maximize resources and prioritize services” to curb the spread of COVID-19.

But as infection cases rose in the third wave of the pandemic, the province ceased all such medical procedures from April 2021 until May 18, 2021, when the directive was rescinded. During the height of the Omicron wave in January 2022, Ontario put non-urgent surgeries on hold for the second time, before resuming them again the following month.

The study used real-world data on cancer care in Ontario between 2019 and 2020 as a model to estimate the wait times for cancer surgery over a six-month period by simulating a slowdown in operating room capacity.

The simulated model population comprised 22,799 patients waiting for cancer surgery before the pandemic, and 20,177 patients during the crisis.

The result shows the mean wait time for surgery jumped to 32 days during the pandemic, up from 25 days in the pre-COVID period.

The simulation estimates a total of 843 years of life were lost among Ontario cancer patients during the first six months of the pandemic due to delays across the province for non-emergency cancer surgery—including those with breast, gastrointestinal, genital and urinary, gynecological, head and neck, liver and gallbladder, and lung and prostate cancers.

The Ontario Medical Association (OMA) estimates it would have already taken at least two years to clear the backlog before non-urgent surgeries were paused on Jan. 4 due to the Omicron variant. A recent study commissioned by the OMA also found that roughly one million fewer surgeries were performed in the province between February 2020 and December 2021.

In total, the pandemic caused a backlog of approximately 20 million patient services, said the OMA, which represents over 43,000 physicians and medical students in Ontario.

“COVID-19 has compounded Ontario’s access to care issues. Thousands of patients across the province now face additional delays in care and are not getting the procedures or surgeries they need within the recommended timelines,” the OMA study said.

“In addition, an unknown number of ’missing' patients require care but have not yet even entered the health system. Physicians are reporting that, due [to] the pandemic, patients who would have been diagnosed and treated sooner are coming in later and sicker.”