A THIRD of cancer surgeons across the UK say they have stopped operating altogether amid fears of potentially deadly complications from coronavirus.
The findings by the Royal College of Surgeons Edinburgh lay bare the impact of the pandemic on cancer patients, with 87 per cent of the specialists surveyed from 150 hospitals nationwide saying they had either ceased or "significantly reduced" work in this area as a result of Covid-19.
The College is calling for some hospitals to be designated as 'Covid-free' to enable cancer and other elective surgeries to resume as safely as possible.
READ MORE: How many of Scotland's Covid deaths are linked to obesity or poverty?
There is no data currently on exactly how many patients in Scotland and the rest of the UK have had cancer procedures put on hold, but the College says medics are being faced with "impossibly difficult" decisions about whether it is safer to delay or proceed with treatment.
The situation is made worse because the novelty of the virus means there is comparatively little evidence to go on.
Patients are known to be more susceptible to contracting Covid after surgery and data not yet published, but shared during an RCSEd webinar earlier this week, indicates that 16% of elective patients who become infected around the time of their operation will die.
Research also suggests that a 60-year-old bowel cancer patient undergoing chemotherapy will see their chances of survival cut to that of an 80-year-old if they catch the virus during treatment.
“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," said Professor Mike Griffin, president of RCSEd.
Prof Griffin, an expert in stomach and gullet cancer, added: “Surgeons are left facing an impossibly difficult question – should I be operating or not?
"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 postoperatively and risking their recovery.”
It came as First Minister Nicola Sturgeon urged people to continue to comply with lockdown measures as she said 1,184 patients have now died after testing positive for the virus in Scotland, up by 64 on the previous day.
However, she said there was "growing cause for optimism that the lockdown is working" after a further reduction in the number of patients in intensive care with confirmed or suspected Covid-19, down seven to 141 - the lowest since March.
The overall number in hospital has also fallen from 1,748 to 1,710.
In addition to disruption to some cancer operations, all elective procedures such as hip and knee replacements were suspended for three months in March to free up beds amid fears the NHS could be overwhelmed by coronavirus admissions.
READ MORE: Hundreds more than normal dying from cancer, strokes and heart disease
The College estimates that around five million operations will have been put on hold UK-wide by the end of the three-month moratorium.
With signs of slowdown, clinical leaders and politicians must now decide how to resume planned surgery safely and who to prioritise.
Official guidance published three weeks ago, and backed by the College, recommended that local health authorities establish so-called "clean" sites which could accelerate the treatment of cancer patients in particular.
These 'Covid-free hubs' would seek to minimise coronavirus levels as much as possible by testing patients 48 hours before admission for surgery and regularly testing staff.
Prof Griffin said private hospitals could take breast or skin cancer patients where surgery is less demanding and unlikely to require intensive care afterwards. He added that this was already happening in Edinburgh.
In cities with more than one hospital, he said Covid patients could be housed in the acute facilities, with separate hospitals designated for cancer and other complex procedures.
However, the 53% of RCSEd fellows surveyed said their NHS trust or health board had not yet set up such a space for major cancer operations to take place, leaving surgeons with no option but to delay vital procedures in many cases.
Professor Griffin said: "There is cooperation between the health boards in Scotland and trusts in England where hospitals which have identified these 'Covid-lite' environments are taking cancer patients from other health boards and trusts in order to continue to look after patients.
"Some health boards and trusts are better placed and more advanced, but I am very anxious that we don't have a postcode lottery for patients getting surgery or not.
"What we have to concentrate on is identifying those environments that allow us to continue operating, particularly on those cancers that are very surgery-dependent where patients would become disadvantaged if they did not get it in a timely fashion.
"A few weeks doesn't make a material difference to outcomes, but once you're into months it can be much more serious."
READ MORE: Warning over surgery backlog as cancer referrals fall 72%
It comes days after figures revealed a 72% fall in the number of patients being urgently referred with possible cancer symptoms, amid a slump in people visiting their GPs.
Prof Griffin said changes to working patterns could help clear waiting lists going forward, but that it would take years for the NHS to return to normal.
He said: "Surgeons generally would be operating one whole day and a half per week. In Europe, most surgeons operate three or four days a week.
"So I think we will see a change to how surgeons and surgical teams are working in the recovery phase.
"We have to think about taking over private hospitals to do cancer surgery and the Nightingale set ups - maybe they can be transformed into extra hospital theatres?"
A spokesman for the Scottish Government said: “We are clear that vital cancer treatments and emergency, maternity and urgent care will continue where that is clinically agreed.
"However, in the current circumstances we have asked NHS boards to postpone their waiting times improvement activities which has resulted in the Waiting Times Improvement Plan being paused.
"Non-life threatening elective procedures have been postponed which will allow vital NHS staff to be redeployed to support the response to the pandemic. We are working hard to ensure vital and urgent care remains, including the use of private hospitals to treat these NHS patients.
"However, 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”.
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