The COVID-19 pandemic - a cause for late presentation of sarcoma patients?

Abstract

Background to the audit: The World Health organization (WHO) declared COVID-19 a global pandemic in March 2020, with subsequent lockdown in the UK and social distancing. There was a subsequent perception of more advanced patient presentation at our regional sarcoma multidisciplinary team meeting (MDTM) (Manchester and Oswestry Sarcoma Service (GMOSS)). Audits of MDTMs were performed prior to and during the pandemic to determine if this was the case. Standard: Local standard was determined by the first audit of MDTMs in 2019. 21.2% presented with metastatic disease. 28.8% had palliative treatment recommendation. Indicator: 1. Percentage of patients with metastatic disease. 2. Percentage of MDTM outcomes recommending palliative treatment. Target: 1. 21% 2. 29% Methodology: GMOSS database MDTM outcomes were obtained for six MDTMs prior to the pandemic, JuneeNovember 2019, to identify a pre-pandemic standard, and then for six MDTMs during the pandemic, JuneeNovember 2020. Benign/relisted patients were excluded. Malignant cases were classed as metastatic or localised. Treatment intent was recorded as radical or palliative. Results of first audit round: 92 patients were discussed, 66 (71.7%) malignant cases. 14 (21.2%) had metastatic disease and 19 (28.8%) had palliative treatment recommendation. First action plan: Compare local pre-pandemic standard to 2020. Results of second audit round: 79 patients discussed, 58 (73.4%) malignant cases. 24 (41.4%) had metastatic disease and 27 (46.5%) had palliative treatment recommendation. Rates of metastatic disease and palliative treatment are higher during the pandemic. Second action plan: Patients are presenting later during the pandemic. For discussion at Greater Manchester cancer pathway board to raise awareness and consider input to primary care and patient education/support. Re-audit required in one to two years.