‘Covid-free’ surgical units for cancer patients could save lives during the UK’s second wave of coronavirus, researchers say.
As hospital admissions for Covid-19 begin to creep up again, medics are desperate to secure beds for cancer patients who also need life-saving treatment.
Researchers led by University of Birmingham assessed the benefit of ‘Covid-19 free’ sites in hospitals, where positive patients are strictly forbidden so that treatment of non-Covid related illnesses can continue.
They looked at the outcomes of thousand of patients worldwide who had cancer surgery between the start of the pandemic and mid-April.
A total of 1.5 per cent of the patients died 30 days after their operation – higher than the pre-pandemic era – with deaths were driven by lung complications, which were lower in the coronavirus-free surgical units, suggesting they were most commonly caused by Covid-19.
But the death rate was lower – 0.7 per cent versus 1.7 per cent – among those treated in Covid-free zones, where coronavirus positive tests were also less common.
When applied to the millions of people who have cancer removal operations a year, the difference of one per cent in mortality could be huge.
It is estimated there are around 550,000 cancer removal operations every year in the UK. If these were to all go ahead in Covid-19 free zones instead of mixed hospitals, it could save some 6,000 unnecessary deaths caused by the coronavirus in the UK alone over the next year, the study claimed.
The death rate was lower – 0.7 per cent vs 1.7 per cent – among cancer patients given surgery in Covid-free zones. This was thought to be due to less Covid-19 infection, and therefore less lung complications
An estimated 2.3million cancer operations were cancelled or postponed worldwide in the first ‘wave’ of Covid-19 to avoid the risk of catching the coronavirus in hospital.
Almost 2.5million people missed out on cancer screening, referrals or treatment in the UK at the height of lockdown, according to Cancer Research UK, even though the NHS was never ovewhelmed as feared would happen.
Experts fear the number of people dying as a result of delays triggered by the treatment of coronavirus patients could even end up being responsible for as many deaths as the pandemic itself.
One of the study’s leaders, Dr Aneel Bhangu, from the NIHR Global Health Research Unit on Global Surgery, at the University of Birmingham, said: ‘Covid-19 free areas could save many lives during future waves, by allowing surgery to continue safely despite high rates of infection in the community.’
The study used data from 9,171 patients in 55 countries across five continents, including 2,679 from the UK, 574 from the US, 1,583 from Italy, 764 from Spain, and also from Australia, Spain, Denmark, China, India, South Africa.
Patients were having surgery for 10 types of cancer including breast, bowel, lung and liver cancer, and were not suspected to have Covid-19.
Surgical units were defined as ‘cold’, meaning the hospital did not admit any Covid-19 patients or had complete segregation between Covid-19 and elective surgery patients, or ‘hot’, when surgical units were not completely segregated.
NHS hospitals were able to care for Covid-19 patients in separate, dedicated areas while patients coming in for elective procedures were cared for in seperate ‘green’ areas.
But due to the risk of vulnerable people picking up the infection, and to free-up beds for Covid-19 patients, millions of cancer patients’ operations were cancelled at the start of the pandemic.
Some private hospital wards were hired by the NHS to act as Covid-19 free zones during the pandemic to help treat cancer and other diseases. For example Royal Stoke University Hospital transferred its cancer treatment to Nuffield Health in Newcastle-under-Lyme.
Just 27 per cent of patients in the study had their care in Covid-19 cold areas.
A total of 1.5 per cent of the patients died 30 days after their operation. But death rates were also lower – 0.7 per cent vs 1.7 per cent – in the Covid-free group.
Of the 30-day deaths, 49.3 per cent were linked with postoperative lung complications, and 44 per cet with Covid-19 infection.
Deaths were driven by lung complications, which were lower in the ‘Covid cold’ surgical units – 2.2 per cent compared with 4.9 per cent. Not all of these deadly lung problems were caused by SARS-CoV-2 infection.
But the researchers said it was plausible that SARS-CoV-2 infection was behind the differences in lung complication rates seen in cold versus hot surgical units.
This cannot be said for certain because testing was not widely available at the start of the pandemic.
This was because a lower number of patients treated in Covid-free units tested positive for SARS-CoV-2, and of those who did, there was a higher rate of lung problems.
Some 2.1 per cent caught SARS-CoV-2 in the Covid-19 free zones compared to 3.6 per cent in the mixed hospitals.
This was even more evidence at hospitals in places with a high Covid-19 infection rate – 3.9 per cent versus 8.2 per cent. But still evident in places with fewer cases.
Older age, male sex, and having surgery in places with a high number of Covid-19 cases in the community raised the odds of these lung problems post-operation, which may suggest they were indeed caused by the coronavirus, given that age and gender are risk factors for Covid-19.
The findings were published today in the Journal of Clinical Oncology.
The authors wrote in their paper: ‘These data support major international redesign of surgical services to provide elective cancer surgery in cold surgical units.
‘Whilst the greatest benefits of cold units were seen in areas of high community SARS-CoV-2 incidence, there was a consistent effect across both high and low incidence areas.
‘Setup of these units is likely to be justified both during the end phases of current lockdowns in preparation for second waves, and in countries managing emerging outbreaks.’
But the researchers noted this may be a difficult feat for hospitals.
‘Governments and hospital providers must help to fund this major international redesign of surgical services and provide protection for patients,’ Dr Bhangu said.
Moving into the ‘second wave’ of the pandemic, a series of NHS hospitals will be designated as coronavirus-free zones, the Guardian reported in September.
Under plans seen by the paper, such ‘clean’ hospitals will as far as possible be kept free of coronavirus patients so that the NHS does not have to completely close to swathes of people with other illnesses.
The findings come after Matt Hancock said today cancer patients will only be guaranteed treatment if Covid-19 stays ‘under control’.
The Health Secretary’s dark comments that it was ‘critical for everybody to understand the best way to keep cancer services running is to suppress the disease’ suggest more patients may face delays to planned surgery and chemotherapy, if the outbreak continues to spiral.
Looking at all non-Covid health problems, millions of Britons are still waiting for treatment after sliding down the prioritisation list to make room for Covid-19 patients.
A record total of 2.15million people – triple the figure for the same time last year – are having to wait more than 18 weeks to start hospital treatment in England, figures show.
Professor Derek Alderson, immediate past President of the Royal College of Surgeons, said one solution to the problem was Covid-19 free zones.
Speaking at a virtual Royal Society of Medicine briefing last month, he said: ‘The solution is we obviously have to look at really quite radical changes in the way we deliver surgical services.
‘In the beginning this has been the creation of what we call ‘Covid-light’ or ‘Covid-free’ sights. We will need to, as it were, consider in a much better way strategic changes in the way in which we deliver complex surgeries and benign surgeries within regions.’