COVID-19 and esophageal cancer care in Australia

The impact of COVID-19 on esophageal cancer diagnosis and treatment has been felt across diagnosis, staging and therapy. During pandemic restrictions, Australian hospitals paused or reduced non-urgent upper gastrointestinal endoscopy, while intensive-care staffing, PPE requirements and infection-control demands reshaped surgical lists. Some patients postponed consultations or investigations because of infection concerns, travel barriers and anxiety about entering hospital.

The virtual ISDE 2021 congress, held from 27–30 September, reflected a global shift toward remote collaboration. Its scientific sessions demonstrated how clinical teams adapted to delayed diagnosis and treatment disruption. The Australian experience also showed that recovery depends on strong referral pathways, accessible specialist care and coordination between hospitals, practitioners and multidisciplinary cancer teams.

Disruption to the diagnostic pathway

Diagnostic delay began before endoscopy. People with dysphagia, persistent reflux, unexplained weight loss or upper abdominal discomfort might wait longer for a general-practice appointment, specialist review and the investigations required to determine the cause. Masks, isolation requirements and concerns about SARS-CoV-2 sometimes made patients uncertain whether hospital attendance was safe.

When endoscopy resumed, infection-control measures reduced available slots and required additional cleaning, protective equipment and screening procedures. Biopsy and pathology workloads remained affected even when procedures returned. Consequently, some patients faced longer waits for diagnosis, staging and oncology consultation, potentially allowing disease to progress before treatment could begin.

Telehealth’s role in specialist care

Australia’s mixed public and private health system allowed rapid use of Medicare-supported telehealth during the pandemic. General practitioners could conduct video or telephone reviews, while gastroenterologists and thoracic surgeons discussed scans, test results and treatment plans remotely. This reduced unnecessary travel and helped maintain communication when face-to-face consultations were restricted.

Telehealth cannot reproduce the information obtained from upper gastrointestinal endoscopy, biopsy or a physical examination. Its value lies in triage, planning and reassurance. For people living outside major cities, including regional and remote communities, specialist consultation through a local GP or hospital service can prevent repeated journeys to metropolitan centres such as Melbourne, Brisbane, Perth or Adelaide. Connectivity and digital literacy, however, remain important barriers.

Changes to surgery and systemic therapy

COVID-19 also disrupted active cancer treatment. Elective esophagectomy and related procedures were postponed when hospitals needed staff and operating space for critically ill patients. Patients already receiving neoadjuvant therapy faced uncertainty about surgical timing, while radiation and systemic treatment required repeated attendance at hospitals and outpatient clinics.

Multidisciplinary teams adapted by reviewing stage, nutritional condition, infection risk and the consequences of further delay. Depending on the tumor and the patient’s fitness, treatment might involve surgery, perioperative chemotherapy, chemoradiotherapy or another planned sequence. Decisions remained individualised: having COVID-19 did not automatically determine cancer treatment, but infection, isolation and reduced immunity required careful risk assessment.

Unequal effects across Australian communities

People in metropolitan areas generally had shorter travel distances to specialist endoscopy and cancer centres. For regional, rural and remote patients, cancelled local services could mean long drives or flights, accommodation costs and time away from work or family. State border controls and quarantine requirements sometimes made interstate treatment even harder, particularly for Aboriginal and Torres Strait Islander patients and communities with limited local health infrastructure.

Culturally and linguistically diverse patients also faced communication barriers when systems moved rapidly online. Remote interpretation is essential, but it must be arranged early rather than added after an appointment is delayed. Public-hospital waiting lists, private insurance arrangements and out-of-pocket costs affected how quickly people could choose an available diagnostic pathway. COVID-safe planning became part of the familiar Australian healthcare juggling act.

Priorities for safer cancer pathways

Australian cancer services can reduce hidden delays by protecting diagnostic capacity and making the route from symptoms to specialist care easier to follow. Practical measures include:

• Establish clear referral criteria for dysphagia and other alarm symptoms, with escalation processes for high-risk patients.
• Protect essential endoscopy, pathology and imaging capacity by separating urgent assessments from routine procedures.
• Combine local clinical reviews with specialist telehealth so regional patients can access oncology and surgical expertise without unnecessary travel.
• Record referral dates, waiting times and reasons for postponement so delays become visible to patients and clinicians.
• Provide trained interpreters and accessible telephone options when video consultations or patient portals are unsuitable.

These measures must fit Australia’s public and private systems rather than assume one national pathway. Regular review of referral-to-endoscopy and diagnosis-to-treatment intervals can reveal bottlenecks, while patient feedback can identify practical obstacles that waiting-list data alone may miss.

Resilient care beyond emergency planning

The pandemic reinforced the value of international knowledge-sharing, scientific meetings and research collaboration. Work presented through ISDE 2021 highlighted how specialists can compare outcomes, refine treatment protocols and identify disruptions earlier. Similar cooperation is essential because future outbreaks, cyber incidents or workforce shortages could again affect diagnosis and treatment.

Resilient systems also need clear ownership of delayed investigations and cancelled procedures. Patients should know who is monitoring their pathway, when the next review is occurring and which symptoms require earlier clinical contact. The next concrete step is for hospitals and cancer networks to audit their diagnostic delays and publish a timetable for correcting the longest bottlenecks.