Cancer patients delay to definitive surgical treatment during COVID-19 pandemic: a literature review after one year of the pandemic

Background: COVID-19 pandemic firstly appeared in December 2019 in China, and was declared a pandemic in March 2020 by the World Health Organization. Since then, health systems worldwide have been dealing with a high incoming surge of patients needing acute care, with a high percentage requiring admi ance to intensive care units for respiratory support. This has led to a shift in primary, secondary, and tertiary health care infrastructure, converting a lot of hospitals from general, surgical or oncologic to COVID-19 treating hospitals. Objective: The aim of this paper is to assess the clinical outcome of oncologic patients in need of surgery during the pandemic. Materials and methods: A wide literature review on MEDLINE, Pubmed and World of Science was conducted. The following keywords were used for search; “elective cancer surgery covid-19”, “delayed cancer surgery covid-19”, “delayed cancer therapy covid-19”, “delayed oncologic surgery covid-19”, Results: A wide variety of cancer surgery has been delayed or postponed due to the COVID-19 pandemic worldwide. Many patients were deferred to alternate non-surgical treatment, chemotherapy or radiotherapy, despite being fit for surgery. Multidisciplinary management were required to delay patients for definitive treatment, or select patients for induction chemotherapy until health system was able to provide a window for surgery between COVID-19 pandemic waves. Discussion: It is wide accepted that delay to definite surgical treatment of cancer in patients who are fit for surgery is closely associated with a decreased rate of disease-free and overall survival of patients. Curative surgical therapy requires the earliest intervention from the time of the diagnosis to the time of surgery. Adjuvant therapy, such as chemotherapy and radiotherapy, is highly effective after tumor resection in less advanced stages of the disease. Any delay in these will highly affect the surgical and oncologic outcome in patents. Conclusion: Surgery for cancer should be continued even in the times of COVID-19. Indirect morbidity and mortality of cancer patients should be accounted for when morbidity and mortality of COVID-19 patients is calculated, since the later prohibits cancer patients from definitive treatment. Elective cancer surgery in COVID free hospitals should be continued.