Table 5. Ancillary determinants of elective breast- and colorectal cancer surgery delays, apart from service suspensions.
| PUBLIC HEALTH DETERMINANTS |
| • Epidemiologic and public health policy considerations: Local COVID-19 prevalence Nationwide lockdown Declaration of national state of emergency Public health messaging to present to hospital only in case of severe symptoms or emergencies Suspension of elective screening- and diagnostic testing services • Access to COVID-19 vaccines not yet established in region or country location |
| INSUFFICIENT HEALTH INFRASTRUCTURE OR PANDEMIC PREPAREDNESS |
| • Resource limitations: Limited availability of COVID-19-adapted clinical guidelines Reduction in number of operational operating theatres, to prevent contamination Limited availability of ‘COVID-19-free’ units Limited availability of smoke filtration equipment for laparoscopy Limited bed capacity due to physical distancing Shortage of PPE, hospital beds, SARS-CoV-2 test kits Reduction in health workforce capacity due to SARS-CoV-2 infection and/or redeployment of healthcare personnel |
| DISRUPTED SERVICE PROVISION PATHWAYS |
| • Positive preoperative SARS-CoV-2 test: (Patient) Admission to COVID-19 unit or 14-day-, home-based self-isolation with repeat, post-convalescence SARS-CoV-2 testing • Slowed service delivery: Requirement for pre-operative, home-based quarantine for defined period (e.g., 14 days) if travelling from out-of-state to undergo surgery at healthcare facility Increased time requirement for sanitisation and ventilation of operating theatres between consecutive procedures • Type of procedure required: Elective breast reconstruction procedures deferred Procedures with high operative time requirement deferred • Disrupted continuity of care: Suspension of multidisciplinary team meetings Decreased frequency of in-person health consultations Diversion of patients to alternative healthcare facilities NACRT halted during regional COVID-19 surges (to minimise immunocompromise) |
| CASE PRIORITISATION REQUIREMENTS |
| • Patient unfit for surgery: Anaesthetic or overall clinical risk profile (age, comorbidities) SARS-CoV-2 infection detected pre-operatively • Case prioritisation per assessment: Staging, grading and tumour characteristics Eligibility for interim medical therapy Risk of any medical or surgical complications secondary to delayed surgery |
| PATIENT-SPECIFIC FACTORS |
| • Social determinants of health: Access to health insurance Residential proximity to health facilities • Individual factors: Care-seeking hesitancy due to fears of contagion Uncertainty regarding navigation of adapted health system pathways Loss of confidence in healthcare provider or health system, change to alternative healthcare provider Decreased acceptability of health service delivery via telehealth platforms Declined consent for surgery Non-adherence to (non-operative) medical treatment Referral to alternative healthcare facilities Loss to follow-up |