It certainly continues to be a very unusual period of time for the entire world, but I am pleased to say that there are now appears to be some clarity about elective surgery, at least during the next few weeks. This is very important for us and for our patients, as CANCER SPECIALISTS is almost completely focused on cancer patients.
Last week seem to be dominated by various announcements, then retractions, and further announcements, on what surgery we can and cannot do in both the public and the private systems from now on. However, as of today, we do now have a much clearer picture which I am happy to outline.
What do we mean by “Category 1” and “urgent Category 2” elective surgery?
This type of language is very familiar to all of us working in public hospitals such as Peter MacCallum Cancer Centre. This is the standard system which is used to stratify elective surgery patients depending on their urgency.
- Category 1 patients are those whom we want to schedule surgery for within 30 days, due to the urgency of their underlying condition. For me as a urologist specialising completely in cancer, this means for example newly diagnosed young patients who I suspect have testicular cancer. It could also be men with an abnormal MRI who I am suspicious may have a very high grade prostate cancer. It may also include new patients who we suspect might have high-grade bladder cancer.
- Category 2 patients are those in whom we would like to perform surgery within 90 days. This includes the vast majority of our cancer patients. For example, it includes patients with clinically significant prostate cancer scheduled to undergo robotic radical prostatectomy (this is the vast majority of my patients). It also includes patients with kidney cancer scheduled to undergo surgery, although some kidney cancer patients are listed as Category 1 if they have a large tumour which is bleeding. Many bladder cancer patients are also in this category.
- Category 3 patients are much less urgent. They include patients undergoing surgery for non-cancer conditions, and those with cancer conditions requiring surgery, but not for urgent reasons. For example, this includes patients with low-grade prostate cancer who are on active surveillance, and to require a further biases from time to time to ensure that the cancer has not become more aggressive. Most of these patients do not need an urgent biopsy. Therefore, all of these Category 3 patients are those whom State and Federal Governments have said should not undergo elective surgery in the coming months.
What is happening in private hospitals?
The vast majority of CANCER SPECIALISTS patients undergo surgery at Epworth Richmond. As of today, only Category 1 and Category 2 patients are allowed to undergo elective surgery at Epworth (or any private hospitals). This means that the vast majority of our patients will undergo surgery as planned.
However, of course, we are all too aware of that coronavirus incidence is rising and is not expected to peak in Victoria for a few more weeks, therefore we have to ensure that all patients are well and fit to undergo surgery. The hospital therefore is contacting all patients ahead of time with some screening questions. There are also a lot of additional precautions in the hospital in line with social distancing and sanitization. We are also contacting patients ourselves responding to queries for the many people who have concerns.
What will happen next?
Who knows??!! We certainly expect further disruption as the weeks go by until we get past the peak of the pandemic. For now, the authorities want us to go ahead and look after urgent cancer patients. We anticipate that we may have to further reduce the amount of surgery we do if the pandemic worsens as seen in other countries. However, we remain very optimistic that the drastic measures already in place, may help us get through this without some of the terrible circumstances seen elsewhere.
Professor Declan Murphy
Consultant Urologist | Cancer Specialists | Peter MacCallum Cancer Centre