• Ambica Parmar, Antoine Eskander, Beate Sander, David Naimark, Jonathan C Irish, and ChanKelvin K WKKWOdette Cancer Centre (Parmar, Chan), Sunnybrook Health Sciences Centre; Department of Otolaryngology-Head and Neck Surgery (Eskander, Irish); Institute of Health Policy, Management and Evaluation (Eskander, Sander, Naimark), University of.
• Odette Cancer Centre (Parmar, Chan), Sunnybrook Health Sciences Centre; Department of Otolaryngology-Head and Neck Surgery (Eskander, Irish); Institute of Health Policy, Management and Evaluation (Eskander, Sander, Naimark), University of Toronto; Toronto Health Economic and Technology Assessment Collaboration (Sander), University Health Network; Division of Nephrology (Naimark), Sunnybrook Health Sciences Centre; Department of Surgical Oncology (Irish), Princess Margaret Cancer Centre; Canadian Centre for Applied Research in Cancer Control (Chan), Toronto, Ont.
• CMAJ. 2022 Mar 21; 194 (11): E408-E414.

BackgroundWith the declaration of the global pandemic, surgical slowdowns were instituted to conserve health care resources for anticipated surges in patients with COVID-19. The long-term implications on survival of these slowdowns for patients with cancer in Canada is unknown.MethodsWe constructed a microsimulation model based on real-world population data on cancer care from Ontario, Canada, from 2019 and 2020. Our model estimated wait times for cancer surgery over a 6-month period during the pandemic by simulating a slowdown in operating room capacity (60% operating room resources in month 1, 70% in month 2, 85% in months 3-6), as compared with simulated prepandemic conditions with 100% resources. We used incremental differences in simulated wait times to model survival using per-day hazard ratios for risk of death. Primary outcomes included life-years lost per patient and per cancer population. We conducted scenario analyses to evaluate alternative, hypothetical scenarios of different levels of surgical slowdowns on risk of death.ResultsThe simulated model population comprised 22 799 patients waiting for cancer surgery before the pandemic and 20 177 patients during the pandemic. Mean wait time to surgery prepandemic was 25 days and during the pandemic was 32 days. Excess wait time led to 0.01-0.07 life-years lost per patient across cancer sites, translating to 843 (95% credible interval 646-950) life-years lost among patients with cancer in Ontario.InterpretationPandemic-related slowdowns of cancer surgeries were projected to result in decreased long-term survival for many patients with cancer. Measures to preserve surgical resources and health care capacity for affected patients are critical to mitigate unintended consequences.© 2022 CMA Impact Inc. or its licensors.

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