Cancer networks as a response to COVID pandemic: A framework from the Italian Society of Surgical Oncology

Abstract

Since the beginning of the coronavirus disease 2019 (COVID‐19) pandemic in Italy, in February 2020, a massive reorganization of the Italian Health System, both on a national and regional level, occurred. During the first wave, efforts were directed to guarantee adequate care to COVID‐19 patients and to minimize viral spread in hospitals and healthcare facilities. Such an emergent re‐organization of the National Health System inevitably determined a thorough review of diagnostic and therapeutic pathways, leading to contrasting results. In this new scenario, the management of cancer patients was deeply influenced. Several studies confirmed that cancer patients have a higher risk of contracting severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) compared with the general population, and to develop a more severe disease. This seems to be related to the state of immunodepression induced by the cancer itself, especially when considering hematological tumors, but also to the immunosuppressive effects of medical and surgical treatments. Moreover, the need for frequent hospital admissions furtherly increases the exposure to viral infection. The need to protect cancer patients and healthcare workers, along with the necessity to provide adequate care, have been addressed by several guidelines, released by national and international oncological and surgical societies. The Italian Society of Surgical Oncology (Società Italiana di Chirurgia Oncologica, SICO) was among the first societies proposing common strategies to guarantee cancer care during the pandemic. During the first few months, the emergency response focused on the identification of priority criteria mainly based on tumor biology, age, and comorbidities as well as the availability of intensive care units. In the most affected Italian regions, “Hub and Spoke” organizational models were proposed, aiming to concentrate the treatment of cancer patients in high‐volume centers, which remained COVID‐free. These actions, however, were not completely successful. A survey conducted on 36 surgical oncology referral centers in Italy recently reported a decrease in surgical activity of approximately 1/3 during the first 5 weeks of the COVID‐19 pandemic. Such rate was as high as 50% in Lombardy, the most affected region at that time. Elective surgery was not the only activity to suffer considerable reductions. In the same setting and during the same period, many other health services linked to cancer diagnosis and treatment were reduced. Among others, endoscopic procedures were cut by 24%, radiologic procedures by 45%, and radiotherapy by 11%. The pandemic also severely affected new diagnoses. In May 2020, the National Screening Observatory (Osservatorio Nazionale Screening) reported an esteemed delay of diagnosis of 2000 breast cancer cases, 4000 high‐risk colonic adenomas and 600 colon cancer cases. Another study, including seven major referral pathology units in Northern and Central Italy, reported a global reduction of approximately 45% in the new cancer diagnoses during the first 11 weeks of the pandemic, compared with the same period of the previous 2 years. The lasting or recurrence of such emergent conditions could lead to devastating effects, resulting in a number of deaths theoretically higher than those actually caused by COVID‐19 itself, as well as to unsustainable economic consequences.