Bone sarcoma surgery in times of COVID-19 pandemic lockdown-early experience from a tertiary centre in India

Assessment of patient satisfaction levels with teleconsultation services at a tertiary care cancer center in a developing country: a cross-sectional study

PURPOSE

Telemedicine use in healthcare is rising. However, infrastructural barriers may impede implementation in lower- and middle-income country settings. Patient perspectives regarding teleconsultation need to be explored. This study assesses the feasibility of teleconsultation among patients with cancer, patient satisfaction with its use, determinants of satisfaction, and its economic benefits.

METHODS

A cross-sectional telephonic interview-based study was conducted between February and September 2021 in a tertiary care cancer center in India. Adult patients with cancer or their caregivers who had availed of teleconsultation during the 6 months preceding the interview date were included. Teleconsultation was administered through email and telephone conversation. The research team developed an interview guide to elicit demographic details, satisfaction with teleconsultation, and the underlying reasons. Cost savings through teleconsultation were also recorded. Factors predicting subject satisfaction were identified by multivariable logistic regression.

RESULTS

During the study period, 195 subjects, including 84 patients (43.1%) and 111 caregivers (56.9%), were interviewed. The median patient age at diagnosis was 31 years. In our study, 147 (75.4%) patients/caregivers reported satisfaction with teleconsultations. The benefits cited included better access and follow-up (n = 173, 88.7%) and saving time and money (n = 164, 84.1%). In multivariable analysis, a higher patient age (more than 30 years) was the only factor predictive of less satisfaction with teleconsultation. The median cost savings were not a predictor of satisfaction.

CONCLUSION

Teleconsultation is feasible and acceptable to most patients availing treatment in a tertiary oncology care setting in India. Patient and physician training for better communication may further improve the utility of this modality.

Impact of the COVID-19 on the surgical management of bone and soft tissue sarcoma: A systematic review

Background

The COVID-19 pandemic had greatly and negatively impacted health services including the management of bone and soft tissue sarcoma. As disease progression is time-sensitive, decision taken by the oncology orthopedic surgeon on performing surgical treatment determines the patient outcome. On the other hand, as the world tried to control the spread of COVID-19 infection, treatment re-prioritization based on urgency level had to be done which consequently affect treatment provision for sarcoma patients. Patient and clinician's concern regarding the outbreak have also inflicted on treatment decision making. A systematic review was thought to be necessary to summarize the changes seen in managing primary malignant bone and soft tissue tumors.

Methods

We performed this systematic review in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 Statement. The review protocol had been registered on PROSPERO with submission number CRD42022329430. We included studies which reported primary malignant tumor diagnosis and its surgical intervention from March 11th, 2020 onwards. The main outcome is to report changes implemented by different centers around the world in managing primary malignant bone tumors surgically in response to the pandemic. Three electronic medical databases were scoured and by applying eligibility criteria. Individual authors evaluated the articles' quality and risk of bias using the Newcastle-Ottawa Quality Assessment Scale other instruments developed by JBI of the University of Adelaide. The overall quality assessment of this systematic review was self-evaluated using the AMSTAR (Assessing the Methodological Quality of Systematic Reviews) Checklist.

Results

There were 26 studies included in the review with various study designs, conveyed in almost all continents. The outcomes from this review are change in surgery time, change in surgery type, and change in surgery indication in patients with primary bone and soft tissue sarcoma. Surgery timing has been experiencing delay since the pandemic occurred, including delay in the multidisciplinary forum, which were all related to lockdown regulations and travel restrictions. For surgery type, limb amputation was preferred compared to limb-salvage procedures due to shorter duration and simpler reconstruction with better control of malignancy. Meanwhile, the indications for surgical management are still based on the patient's demographics and disease stages. However, some would stall surgery regardless of malignancy infiltration and fracture risks which are indication for amputation. As expected, our meta-analysis showed higher post-surgical mortality in patients with malignant bone and soft tissue sarcoma during the COVID-19 pandemic with odds ratio of 1.14.

Conclusion

Surgical management of patients with primary bone and soft tissue sarcoma has seriously been affected due to adjustments to the COVID-19 pandemic. Other than institutional restrictions to contain the infection, patient and clinician's decisions to postpone treatment due to COVID-19 transmission concern were also impactful in treatment course. Delay in surgery timing has caused higher risk of worse surgical outcome during the pandemic, which is aggravated if the patient is infected by COVID-19 as well. As we transition into a post-COVID-19 pandemic period, we expect patients to be more lenient in returning for their treatment but by then disease progression might have taken place, resulting in worse overall prognosis. Limitation to this study were few assumptions made in the synthesis of numerical data and meta-analysis only for changes in surgery time outcome and lack of intervention studies included.

Changes in the Management of Malignant Bone Tumors in the COVID-19 Pandemic in Developing Countries

The COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has drastically affected healthcare delivery to cancer patients, including those with malignant bone tumors, worldwide. Such cancer patients are more susceptible to COVID-19 infection and risk contracting the severe disease, but their holistic tumor management has also suffered a significant impact. Because of the acute shortage of healthcare resources due to their diversion in COVID management, substantial changes are needed in various aspects of management for high-grade tumor patients, particularly in developing countries and population-dense regions, so that their evidence-based appropriate treatment is ensured. Owing to a lack of consensus regarding the ideal course of action for the management of malignant bone tumors in the current situation, many such patients often get neglected, leading to loss of life/limb. This review elaborates on various guidelines proposed by different healthcare organizations and institutes regarding the modified care pathways for malignant bone neoplasms in the current coronavirus pandemic. The early published results of these modified care pathways and the changes in the oncology practice brought about by the pandemic are also discussed.

Bone sarcoma surgery in times of COVID-19 pandemic lockdown-early experience from a tertiary centre in India

BACKGROUND AND OBJECTIVES

Coronavirus disease 2019 (COVID-19) lockdown has presented a unique challenge for sarcoma care. The purpose of this study is to evaluate the early results and feasibility of surgeries for bone sarcomas during the COVID-19 lockdown.

METHODS

Our prospectively collected orthopaedic oncological database was reviewed to include two groups of patients- those who underwent surgery in the immediate 4 weeks before lockdown (non-lockdown group) and those operated in the first 4 weeks of lockdown (lockdown group). All patients were followed-up clinically and telephonically to collect the outcome data.

RESULTS

Out of the 91 patients who qualified for inclusion, fifty were classified into the non-lockdown group while 41 patients formed the lockdown group. Both the groups were comparable with respect to baseline demographic parameters. However, during the lockdown period 37 patients (90%) had undergone a major surgical intervention as against 24 patients (48%) in the non-lockdown group (P < .001). There was no significant difference in type of anaesthesia, median estimated blood loss and procedure duration. None of the patients/health care workers had evidence of severe acute respiratory syndrome-coronavirus 2 infection at 15 days follow-up.

CONCLUSION

Our study results suggest that appendicular bone tumours can be safely operated with adequate precautions during the lockdown period.