Non-Emergent Oncologic Surgery Cancellation During the COVID-19 Pandemic: A Risk-Benefit Analysis

The COVID-19 pandemic was a devastating worldwide event with great consequences on medical and surgical care that has not been fully evaluated. The pandemic caused an imbalance between rapidly increasing patient needs and limited hospital resources such as staff, personal protective equipment (PPE), and open beds. As a result, surgeons in the United States were encouraged or required to postpone "non-emergent" operations, including some cancer surgeries, in March of 2020. Resource allocation during the pandemic focused on the needs of the community to accommodate potential surges, and cancer patients needing "non-emergent" operations had operations delayed. This paper is an ethical analysis based on the review of the literature covering a range of topics from known harms due to certain operation delays, to COVID-19 caseloads, to triage ethics. The key surgery types examined were cancer surgeries for a wide range of organ systems. Many mandates for suspension of surgical care came from the national level without consideration of the local COVID-19 caseload, which was variable. It could be argued that the physical and mental harm sustained by patients whose disease progressed as a result of surgery delay outweighed the benefits of preserving resources, particularly in the regions with low COVID volumes. This paper uses the principles of medical ethics within a public health framework to examine the ethical issues surrounding the cancellation of oncologic surgeries and makes recommendations for times of future resource strain.