ONCOLOGY
Preparing colposcopy clinics: post-COVID-19
Earlier this year, Professor John Tidy of Sheffield Teaching Hospitals NHS Foundation Trust and Ms. Uma Krishnamoorthy of East Lancashire Hospitals NHS Trust conducted a webinar, ‘Bringing colposcopy back to a new normal and how to manage the challenges’, to discuss the impact and potential adjustments cervical cancer services are facing as a result of the coronavirus pandemic.
The COVID-19 pandemic has affected all aspects of healthcare in the United Kingdom as the NHS cleared capacity in hospitals to deal with the crisis. With cervical screening invitations paused in Northern Ireland, Wales and Scotland and in England clinics only seeing urgent referrals, many colposcopy services found themselves surprisingly empty, with some operating at only 20% capacity. Physical distancing, the pressures on capacity due to the extension of appointment times, and reduced capacity caused by the demand of new hygiene protocols and application of PPE has driven the desire to manage patients appropriately at their first visit and remove the need for subsequent follow up visits.
This suspension of usual service has accrued a backlog roughly estimated to be a minimum of 20,000 patients waiting for colposcopy examination. This is in addition to an already inflated number of referrals due to the implementation of HPV primary screening across the UK this year. Additional to this, a number of centralised labs relied upon to process HPV and cytology screening tests and biopsies are also COVID-19 test centres and are increasingly impacted by the wider Government roll- out of testing. Maintaining staffing levels in clinics can also be a challenge as many administrative and clinical staff are redeployed or still required to shield or self-isolate. As the COVID-19 crisis rolls on, there is an increasing demand for the return to ‘business as usual’ in cancer services despite the ongoing reduction in capacity caused by increased appointment times required to apply PPE, lengthy cleaning schedules between patients, and the pressures of maintaining social distancing in waiting areas. Alongside, there needs to be some sensitivity to the patients who are still nervous about
attending hospital appointments. It has been recently reported that 600,000 women have had cervical screening delayed due to the COVID-19 efforts and with screening now opening back up across the UK, further referrals in the coming weeks will add significant pressures to colposcopy services. So, what can we do differently to clear the backlog and deliver efficient, effective diagnosis and treatment of patients, while maintaining compassionate service and dignity for the patient in this radically changed environment? Some services, such as those of East Lancashire Hospitals NHS Trust, have already implemented an increase in telephone consultations to help reassure women whose appointments or test results have been delayed and conduct individual risks assessments prior to a physical appointment. This helps to allay the fears a patient may have around entering a hospital environment at this time and talk them through the procedure without the depersonalising PPE that makes
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communication so hard. Extended clinic hours and waiting in the car in the hospital car park or outside the hospital right up until the appointment time could also become the norm, as we seek to avoid concentrating numbers in waiting areas. As it is widely reported that around 20%1 of infections are acquired in the hospital environment, there may even be scope to move colposcopy services out of the hospital environment entirely. Within the backlog, most of the referrals will be low grade cell changes or high-risk HPV positive with negative cytology, which are the most challenging patients for us to access colposcopically. As clinicians seek to manage increased caseloads of both high and low-grade abnormalities with reduced capacity, there will be increasing need to optimise patient management in the minimum number of visits to colposcopy. Sheffield Teaching Hospitals NHS
Foundation Trust is using adjunct technology (ZedScan, electrical impedance spectroscopy, from Zilico) to release patients back to surveillance or three to five-year
OCTOBER 2020
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