P28 The impact of the COVID-19 pandemic on pleural and lung cancer activity at Plymouth NHS Trust

Abstract

<h3>Background</h3> The UK lockdown introduced on 23rd March 2020 to flatten the curve of the COVID-19 pandemic was associated with a decrease, or cessation, of most non-COVID-19 NHS services, affecting other patient groups requiring time-critical access to NHS services. <h3>Objectives</h3> We assessed the impact of COVID-19 on our pleural service. <h3>Methods</h3> All patients referred to the pleural service during the official period of lockdown 23/3/20–11/5/20 (7 weeks) were identified alongside those referred in the preceding and following 7 weeks. Patient demographics, number and type of referrals (2 week wait, in-patient or out-patient), length of time to see the patient, procedures performed and ultimate diagnosis from the referral were collected. We defined cancer based on new diagnosis or management of malignant effusions and suspected pleural infection based on investigation for pH&lt;7.2. <h3>Results</h3> During this 21 week period 401 patients were referred to the pleural service. The mean±SD age was 67.4± 15.4 years and 285/401 (71%) were male. Referrals dropped by 23% during lockdown returning to normal in the 7 weeks post lockdown. From baseline cancer diagnoses increased by 24% during lockdown and 53% in the 7 weeks following lockdown (Graph 1). This increase in cancer diagnosis was secondary to in-patient referrals (pre, during and post lockdown: 6/23(26%), 14/22(63%) and 15/25(60%) respectively (p=0.02). Suspected pleural infection referrals reduced by 21% during the lockdown. Time from referral to review increased from 1[1–2]days to 3[1–5]days during the lockdown, reducing to 2[0–4]days post lockdown (p=0.002). The subsequent delays driven by mandatory swabs to exclude SARS-CoV-2 infection prior to review. <h3>Conclusion</h3> Due to the national lockdown a reduction in referrals to our pleural service was observed, particularly affecting reviews and suspected pleural infection, but interestingly not cancer diagnoses. However, consequently we have seen an increase in diagnosis in malignancy and pleural infection driven through our in-patient cohort rather than 2 week wait referrals, indicating a probable delay in seeking medical attention or higher threshold for referral during the lockdown. COVID swabbing has impacted our timeliness to review urgent outpatients. The effect of COVID-19 lockdown will continue, and the true impact is yet to be determined.