Editor
The COVID-19 pandemic is having a significant impact on the delivery of colorectal cancer (CRC) care, among other surgical services, due to the need to modify and redirect resources1–3. Screening, diagnostic imaging and treatment are being delayed. The potential for enteric virus shedding is considered to represent a transmission risk, leading to widespread recommendations to withhold colonic investigations4. Difficult triage decisions have to be made at multidisciplinary meetings because of the limited operating space and intensive care facilities. Current guidance suggests very broad recommendations on how to prioritize operations, ultimately leaving it to the doctors to risk-stratify. NHS England guidance suggests that all non-obstructing colorectal cancer operations can be delayed for up to 3 months. This all represents new ethical challenges in high-income countries not used to rationing services5.
The aim of the CRC COVID study is to describe changes in CRC services in response to the pandemic, the impact that ensues, and sensible ways to recommence surgery6. Resource allocation and approach to the management of CRC during the pandemic may vary from country to country. Gaining insights from all perspectives will inform problem-solving. Goals include to outline consensus recommendations for sustainable modifications and predict additional resources required to treat patients whose treatment has been affected. Highlighting the needs of colorectal patients and the costs required to deliver high-quality care in the future is the ultimate priority. The service evaluation will be conducted in four phases (Fig. 1).
Fig. 1.
Colorectal cancer service evaluation during COVID-19 pandemic
NHS, National Health Service.
Supplementary Material
Appendix S1. Authorship
Contributor Information
The CRC COVID research collaborative:
A Courtney, A M Howell, N Daulatzai, N Savva, O Warren, S Mills, S Rasheed, G Milind, N Tekkis, M Gardiner, T Dai, B Safar, J E Efron, A Darzi, C Kontovounisios, and P Tekkis
References
- 1. Spinelli A, Pellino G. COVID-19 pandemic: perspectives on an unfolding crisis. Br J Surg 2020; 10.1002/bjs.11627 [Epub ahead of print]. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2. COVIDSurg Collaborative . Global guidance for surgical care during the COVID-19 pandemic. Br J Surg 2020; 10.1002/bjs.11646 [Epub ahead of print]. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3. Søreide K, Hallet J, Matthews J, Schnitzbauer A, Line P, Lai P. Immediate and long-term impact of the COVID-19 pandemic on delivery of surgical services. Br J Surg 2020; 10.1002/bjs.11670 [Epub ahead of print]. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4. Gu J, Han B, Wang J. COVID-19: gastrointestinal manifestations and potential fecal–oral transmission. Gastroenterology 2020; 158: 1518–1519. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5. Ives J, Huxtable R. Surgical ethics during a pandemic: moving into the unknown? Br J Surg 2020; 10.1002/bjs.11638 [Epub ahead of print]. [DOI] [PubMed] [Google Scholar]
- 6. Di Marzo F, Sartelli M, Cennamo R, Toccafondi G, Coccolini F, La Torre G et al. Recommendations for general surgery activities in a pandemic scenario (SARS-CoV-2). Br J Surg 2020; 10.1002/bjs.11652 [Epub ahead of print]. [DOI] [PMC free article] [PubMed] [Google Scholar]
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Supplementary Materials
Appendix S1. Authorship