Conflicted cancer surgeons call for 'Covid-free hubs'

Cancer surgeons are facing “an impossibly difficult question” of whether to operate or not during the coronavirus outbreak, the head of a professional organisation has said.

Royal College of Surgeons of Edinburgh (RCS) president Professor Michael Griffin is leading calls for more “Covid-free hubs” to be available so life-saving procedures can go ahead.

The RCS, which represents 15,000 members UK-wide, conducted a survey of its fellows and found a third of those who carry out cancer operations have completely stopped them.

It also found 87% of cancer surgeons have reduced the number of operations taking place despite Public Health England guidance to introduce these Covid-free hubs in a bid to continue procedures while minimising transmission.

More than half (53%) of those surveyed by the RCS said their NHS trust or health board had not yet set up such a space for these major cancer operations to take place.

Prof Griffin said: “Surgeons are facing an extremely difficult time right now when it comes to performing surgery in what we call Covid-rich environments.

“Major surgeries on certain cancer types have very significant risks attached to them and performing them in an environment where coronavirus is present could potentially outweigh the risk of delaying surgery.

“If you don’t, you could reduce the chances of curing a patient’s cancer, but if you go ahead, you could be increasing their chance of catching Covid post-operatively and risking their recovery.”

The hubs can be private hospital spaces solely for non-coronavirus purposes, or in certain cities which have more than one hospital.

Prof Griffin’s comments come days after Matt Hancock said he could not guarantee all cancer treatment would go ahead.

The Health Secretary said there are some treatments “clinically inadvisable” due to the risk of catching Covid-19.

Prof Griffin said the main issue is having “no uniform approach across the country”.

He said: “A cancer patient in one part of the country could receive a completely different course of treatment to someone in another region depending on whether there is a Covid-deficient environment available for them to operate in.

“Where possible we must maintain consistency of treatment, and for this reason, we need more of these hubs where the presence of coronavirus is minimised.

“Of course it’s not possible to socially distance all the time when working in a hospital environment.

“But by taking this into account and minimising contact in group meetings, medical staff can ensure they are creating as much of a Covid-deficient space as possible.

“We need a unified approach to avoid a scenario where patients find themselves facing a postcode lottery, and the only way to achieve this is with more suitable spaces to carry out vital operations.”

John Appleby, chief economist at the Nuffield Trust, has also written in the British Medical Journal, saying the measures being taken to deal with Covid-19 may be having a negative effect on other causes of death.

Citing a fall in those attending emergency departments he said “the fear would be that some who didn’t attend … will have died or may die in the coming months, when timely treatment may have prevented their death”.

But he added: “The data are incomplete, too uncertain, and too fast moving to support any reliable conclusions.”

A Scottish Government spokeswoman said: “We are clear that vital cancer treatments and emergency, maternity and urgent care will continue where that is clinically agreed.

“We are working hard to ensure vital and urgent care remains, including the use of private hospitals to treat these NHS patients.

“However, we recognise the significant pressure that our NHS is under and we cannot underestimate the risks from Covid-19 particularly for some cancer surgical procedures and, therefore, for some cancer patients treatment plans may change over the coming weeks and months.”

The UK Government has been asked for comment.