Impact of Multiple COVID-19 Waves on Gynaecological Cancer Services in the UK

SIMPLE SUMMARY: This study aimed to assess the impact of multiple COVID-19 waves on gynaecological cancer services across the UK. A survey was sent to staff in UK cancer hospitals after the first wave in 2020, and this was repeated for the second and third waves in 2021 and 2022. This showed that referrals halved during the first wave, and half of hospitals reported reduced staffing. The number of operations performed substantially fell, with many being postponed. Many hospital meetings and appointments were conducted by videoconferencing or telephone rather than in-person. By the second wave, referrals were at normal levels, with fewer reductions in staffing, operations, and other services. By the third wave, there were worse staffing reductions, similar to 2020, despite normal workloads. Our analysis shows the major impact of COVID-19 on gynaecological cancer services, highlights serious staffing shortages, and gives insights into the adaptations needed in the future. ABSTRACT: Background: This study aimed to assess the impact of multiple COVID-19 waves on UK gynaecological-oncology services. Methods: An online survey was distributed to all UK-British-Gynaecological-Cancer-Society members during three COVID-19 waves from 2020 to2022. Results: In total, 51 hospitals (including 32 cancer centres) responded to Survey 1, 42 hospitals (29 centres) to Survey 2, and 39 hospitals (30 centres) to Survey 3. During the first wave, urgent referrals reportedly fell by a median of 50% (IQR = 25–70%). In total, 49% hospitals reported reduced staffing, and the greatest was noted for trainee doctors, by a median of 40%. Theatre capacity was reduced by a median of 40%. A median of 30% of planned operations was postponed. Multidisciplinary meetings were completely virtual in 39% and mixed in 65% of the total. A median of 75% of outpatient consultations were remote. By the second wave, fewer hospitals reported staffing reductions, and there was a return to pre-pandemic urgent referrals and multidisciplinary workloads. Theatre capacity was reduced by a median of 10%, with 5% of operations postponed. The third wave demonstrated worsening staff reductions similar to Wave 1, primarily from sickness. Pre-pandemic levels of urgent referrals/workload continued, with little reduction in surgical capacity. Conclusion: COVID-19 led to a significant disruption of gynaecological-cancer care across the UK, including reduced staffing, urgent referrals, theatre capacity, and working practice changes. Whilst disruption eased and referrals/workloads returned to normal, significant staff shortages remained in 2022, highlighting persistent capacity constraints.