Weathering the Storm: The Impact of Weather Events, Lockdowns and Holidays on Oncology and General Emergency Presentations to a United Kingdom Tertiary Centre-A 7.5-year Review

Abstract

Aims

Weather extremes, public holidays and weekend effects modulate emergency department activity. Their impact on oncology-specific emergency presentations remains poorly defined. The aim of this study was to determine how COVID-19 lockdowns, weather extremes, and calendar factors influence oncology emergency presentations versus all-cause emergency presentations at a United Kingdom tertiary academic centre.

Materials and Methods

We conducted a 7.5-year retrospective time-series analysis of daily oncology-specific and all-cause emergency presentations (1/01/2017-9/7/2024). A quasi‑Poisson distributed lag non-linear model quantified same-day and cumulative (0-21 day) effects of COVID-19 lockdowns, weather extremes (≤2.5^th or ≥97.5^th percentile), public holidays, and day of the week, on daily presentation rates.

Results

Of 970,884 emergencies, 27,946 (2.9%) were oncology-specific. Lockdowns reduced oncology emergencies by 11% (cumulative relative risk [RR] = 0.89; 95% CI: 0.80-0.99, P = 0.034) and all-cause attendances by 6% (cumulative RR = 0.94; 95% CI: 0.92-0.97, P < 0.0001). Both rebounded after lockdown. Oncology presentations showed no significant association with extreme cold/heat, heavy rainfall or snow, whereas all-cause attendances rose 6% in very-cold weather (cumulative RR= 1.06; 95% CI: 1.03-1.10, P = 0.0009) and fell 7% in heavy rain (cumulative RR = 0.93; 95% CI: 0.89-0.98, P = 0.002). Public holidays halved oncology emergencies (cumulative RR = 0.49; 95% CI: 0.44-0.55, P < 0.001) versus a 9% fall in all-cause emergencies (cumulative RR = 0.91; 95% CI: 0.90-0.93; P < 0.0001). The Boxing Day to New Year period increased oncology emergencies by 21% (same day RR = 1.21; 95% CI: 1.09-1.33, P = 0.0002) and all-cause by 4% (cumulative RR = 1.04; 95% CI: 1.02-1.06, P = 0.001). Weekend volumes for oncology emergencies fell 58% (cumulative RR = 0.42; 95% CI: 0.39-0.45, P < 0.0001), compared with a 15% decrease in all-cause emergencies (same day RR = 0.85; 95% CI: 0.84-0.86, P < 0.0001).

Conclusion

Oncology emergency demand was significantly influenced by calendar constraints (public holidays, weekends, lockdowns) but not by weather extremes. All-cause emergencies were influenced by both calendar and weather extremes. Calendar-based rostering of oncology staff around holiday periods and weekends may therefore yield greater benefit than weather-triggered surge plans. Validation in centres with wetter or more extreme climates is warranted.