'Permissive' Operative Strategy for Surgical Oncological Care during COVID-19

COVID-19 Research Area(s): Healthcare Delivery & Policy

1. Purpose: To evaluate the potential impact of COVID-19 related system-wide re-prioritization related to the cancellation of non-emergent surgical specialist services (i.e. diagnostics and cancer operations) on the care and potential outcomes for cancer patients.
2. Hypothesis: During the COVID-19 pandemic and future outbreaks, use of a 'permissive' operative strategy that allows continued urgent or emergent oncological care for breast and colorectal malignancies is feasible and safe under the following conditions: case prioritization guidelines are set, rigorous personal protective equipment (PPE) operating room (OR) precautions are established and surgical team directed COVID-19 testing employed to maintain the safety of patients and their health care teams.
3. Justification: In the midst of the COVID-19 pandemic, health systems globally have been under pressure to curtail the spread of the SARS-CoV-2 virus. The growing shortage of PPE and ventilators and the redeployment of human resources has been unprecedented. In order to create surge capacity, hospital systems have had to cancel non-emergency specialist surgical services including diagnostics and cancer operations. Additionally, due to the focus on flattening the curve through social distancing, screening programs and referrals from primary care physicians for asymptomatic and symptomatic patients have been delayed. The hidden cost of these measures on the care of cancer patients has been underrecognized, and the potential effects on cancer outcomes could be profound.