Reducing the treatment burden of keratinocyte cancers requiring referral to plastic surgery: Lessons from lockdown

Abstract

AbstractBackgroundKeratinocyte cancers are increasing in incidence in Ireland and are more common in older age, necessitating multidisciplinary specialist input and treatment often is a greater burden for patients. The coronavirus disease 2019 (COVID‐19) allowed us to restructure our interspecialty treatment pathways to reduce healthcare contact for patients.ObjectivesThe aim of this study was to establish whether a revised interspecialty pathway reduced the time‐to‐treatment completion (days) and treatment burden (defined as total healthcare encounter days).MethodsPatients with keratinocyte cancer under the care of dermatology and plastic surgery at St Vincent's University Hospital Dublin from July to December 2020 inclusive were identified in the Hospital‐Inpatient Enquiry database. Treatment burden was captured as the number of total days with a healthcare encounter and time‐to‐treatment completion was captured as the time from initial dermatology review to complete excision by plastic surgery.ResultsForty patients with 49 keratinocyte cancers were referred by dermatology to plastic surgery from July to December 2020. Thirty‐nine patients with 48 keratinocyte cancers were included in the analysis. The new referral pathway reduced the time‐to‐treatment completion from a mean of 164 to 75 days (p = 0.04). Treatment burden reduced from a mean of 5.4 to 3.5 (p = 0.002) total healthcare encounter days.ConclusionsMultidisciplinary input to establish a more efficient referral pathway for patients with keratinocyte cancer has successfully reduced the time‐to‐treatment completion and the treatment burden for our patients. This approach reduced the risk of exposure to COVID‐19 for patients and frees up valuable healthcare resources to treat these increasingly frequent malignancies.