BAOMS/COVIDSurg snapshot survey results warn of looming crisis
25 February 2021 (Last updated: 25 Feb 2021 07:21)
BAOMS/COVIDSurg snapshot survey results show 50% of head & neck cancer patients had altered treatment in COVID second wave and warn of looming crisis in surgery
The British Association of Oral and Maxillofacial Surgeons (BAOMS), contributors to the COVIDSurg Collective snapshot survey, warn of a looming crisis in patient access to timely cancer surgery across the country. The joint survey involving BAOMS gives a fast turnround picture of the provision of care for head and neck cancer (H&NCa) patients that need urgent surgery as part of agreed treatment plans.
Survey findings show half of all H&NCa patients received altered, possibly compromised treatment as a result. The intense pressures on critical care units (CCUs) in the COVID pandemic means that major H&NCa operations are delayed or even unavailable despite local innovations, even in the largest cancer centres.
BAOMS President Austen Smith said: “The existing NHS solutions are effective, but work to a time frame that often does not respond quickly enough. It should be possible to co-ordinate patients’ transfers rapidly from struggling units to centres with some capacity for surgical procedures and post-operative critical care. Many major hospitals can struggle, as centralised services tend to sit within large populations where COVID is a major problem.
“I have been contacted by colleagues from London, the Midlands, North of England and elsewhere who say there is a worsening availability of the critical care needed to support major surgery,” the Sheffield-based H&NCa surgeon explained. “Some major H&N cancer centres have been unable to accommodate vital H&N surgical procedures. Transfer to units with capacity in a timely way is of the utmost importance. Speed is of the essence here. Delay in planned surgery results in disease progression and poorer patient outcomes.”
Key BAOMS/COVIDSurg survey findings
- 50% of UK H&N cancer patients requiring surgery have significantly compromised treatments during the second COVID wave.
- Of the 50%: 28% suffered delays; 10% received radiotherapy instead of surgery; and 12% received de-escalated surgery.
- Surgical capacity was 58% of pre-pandemic level compared with 62% in the first wave.
Richard Shaw, Professor of Head and Neck Surgery based at Aintree University Hospital and co-author of the snapshot survey paper (*see Notes below), said: “This is an important study that has evaluated the differences in surgical capacity for H&N cancer in the UK between the first Covid wave and the current wave. The effectiveness of central or regional strategic response to the mismatch of demand and surgical capacity will directly affect our head and neck cancer patients. Currently it is clear some centres cannot cope. Liverpool has offered help to colleagues in other cities.”
BAOMS Lead Consultants for Cancer Brian Bisase (Queen Victoria Hospital East Grinsted) and Leo Vassiliou (East Lancashire Hospitals) co-ordinated responses from UK OMFS members. They said that few patients were being redirected away from hospitals overwhelmed by COVID: “We called on our BAOMS colleagues to use the BAOMS website Forum to speed contact and facilitate collaboration between the units who needed, and those who could provide, H&NCa operating capacity. This speeds up the usual communications channels and gives an updated status report to colleagues to work with and help the NHS and Cancer Alliances.”
They confirmed that BAOMS will continue to contribute where and when it can to support the NHS with the unprecedented Covid threat, and help to ensure the efficient transfer of patients to where they can access timely treatment.
For further information and interviews contact: Siân Evans on 020 8674 8921 / 07752 414433 / or BAOMS
Notes to editors
- The British Association of Oral and Maxillofacial Surgeons (BAOMS) promotes the advancement of education, research and the development of oral and maxillofacial Surgery in Great Britain, and encourages and assists postgraduate education, study and research.
- Austen Smith, BAOMS President, is Head and Neck Surgeon at Sheffield Teaching Hospitals & Barnsley Hospital.
- *Professor Richard Shaw, Professor of Head & Neck Surgery, Honorary Consultant in Oral & Maxillofacial Surgery, Associate Director & Surgical Oncology Specialty Lead, NIHR Clinical Research Network (Cancer), Chair of COVIDSurg-HN. He is co-author of: UK Head and Neck cancer surgical capacity during the second wave of the COVID-19 pandemic – have we learned the lessons?
- Head and neck cancer surgery during the COVID‐19 pandemic: An international, multicenter, observational cohort study
- CovidSurg is a platform of studies aiming to explore the impact of COVID-19 in surgical patients and services. The studies are designed and delivered by an international collaborating group of surgeons and anaesthetists.
Further information
The UK Head and Neck cancer surgical capacity during the second wave of the COVID-19 pandemic – have we learned the lessons? study, is a snapshot of the immediate past situation. BAOMS President Mr Austen Smith explains that it is timely, extremely relevant, useful for planning purposes and demonstrates a number of points:
- It is possible in the modern environment to conduct rapid, worthwhile and relevant sampling of clinical processes given collaboration from clinicians in the main centres of provision.
- The likely future for audit evaluation and monitoring of UK wide specialist H&N surgical services is co-ordinated data collection on a national basis.
- There is cause for concern about just how rapidly the appropriate transfer of patients is being achieved from centres incapable of completing the multidisciplinary team (MDT) treatment plan to another less stressed centre.
- Head and neck cancer surgical procedures often incorporate four or five component operations, which for advanced cancer tumour cases often requires an all-day operating list. Patients have to recover in a CCU where they are closely monitored post-operatively for between 24 to 48 hours.
- Patients in H&NCa are under time pressure to complete their treatment, and any substantial delay can and will affect the stage or prognosis of their situation. The Cancer Alliances are also facing the same issue across all cancer types and services in the UK.
- The Royal College of Surgeons of England (RCSEng) has very recently voiced concerns about the huge waiting list for operations that has built up over the last year, and has asked for public understanding as the NHS works to restore timely access to surgery.
- BAOMS fears that despite the protection of cancer surgery throughout the pandemic, H&N cancer operations could be overwhelmed by the tidal wave of delayed surgery for other conditions deferred during the crisis.
BAOMS has co-ordinated communication between those members active in H&NCa surgery to update and possibly offer ready-made solutions. Over 200 responses have been logged through their website Discussion Forum, with two main goals to:
- Identify clearly the best contact at each site for discussions around transfer in or out of H&N cancer patients where the prospect of delayed operating might adversely affect their prognosis.
- Update colleagues in real-time with the local situations and developments that relate to H&N cancer operating availability.
This initiative is intended NOT to supplant the NHS due process, but offers in some cases a ready-made solution in timely fashion, with local specialist knowledge of the viability of patient transfers.
BAOMS H&N Oncology Specialist Interest Leads are Mr Brian Bisase and Mr Leo Vassiliou, who can be contacted by email:
Brain Bisase
Leo Vassiliou
Further advice from the BAOMS Office
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