COVID-19 related delays in diagnosis and intervention for patients with malignant bone tumours-recommendations for future pandemic planning

Introduction: During the COVID-19 pandemic, UK cancer-screening services were suspended. We aimed to investigate whether COVID-19 restrictions caused delays in diagnosis and interventions for bone tumour patients.Materials and Methods: A retrospective cohort study (2018-2020) was undertaken in patients referred to an orthopaedic department, with radiological or biopsy-proven malignancy with complete or impending pathological fractures. Patient demographics, dates of referrals and intervention were extracted from local Bony Metastasis Registry (TBMR). Minimum follow-up =18-months.Results: The total number of orthopaedic malignancy referrals was higher in June 2020 (n=13) vs 2018 (n=4) &2019 (n=5). In 2020, time between a referral for suspected malignancy and investigation was longer than 2019 (p=0.29). Time between investigations and diagnosis was significantly less in 2020 (7±9 days, p=0.02) vs other years (28±49 days, 2018, 12.5±21.5 days, 2019). Time between medical intervention and death was less in 2020.Discussion & Conclusions: Data suggests higher numbers of patients with new pathological lesions presented after initial UK lockdown suggesting delayed presentation. Time from referral to surgical intervention and from surgery to death was significantly reduced, suggesting missed interventional opportunities leading to increased morbidity &mortality. This highlights the impact of COVID-19 restrictions on bone tumour patients and emphasizes considerations for pandemic planning of cancer services