The impact of COVID-19 jolted the system and changed our normality. The healthcare system is also working differently and subject to new regulations and challenges.
The impact of SARS COV 2 infection is also in the management of hospital care. Some hospitals became referrals for COVID care.
Many non-COVID hospitals and clinics had to shut down outpatient appointments and some elective procedures. Cancer care and referrals are also becoming a growing challenge during coronavirus.
After more than one year with COVID-19, the results of delayed care and decline in outpatient appointment is now emerging. It is particularly evident in patients with chronic and life-threatening diseases such as cancer.
Having their treatment canceled or postponed has often led to worsening of their condition and growing complications.
It is not only a viral infection causing a respiratory condition in COVID 19 patients. Its consequences have had a hidden impact in non-infected patients that is now becoming evident. For example, in the field of cancer referrals and treatment.
In this article, we’re reviewing the evidence to know how coronavirus disease impacts cancer patients’ lives and what we can do about it.
For that purpose, we will analyze findings from a systematic review and specific data from various countries.
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Drop in cancer referrals
One of the reasons for the delay in diagnosing cancer during coronavirus is a significant drop in cancer referrals.
According to a systematic review including data from 62 studies, the leading cause of cancer referral reduction was a decrease in availability. Cancer care often becomes unavailable in this crisis for many reasons.
One of them is a reduction in routine activities in the medical community-for example, a decrease in-home visits to the elderly and screening.
Patients are often not informed about cancer and do not recognize the signs. Thus, limited contact with their primary care physician reduces the chance of spotting cancer from an early stage.
Going directly to the hospital is not guarantee an appropriate diagnosis, either.
Personnel reduction was reported in up to 60% of patients in the study. This personnel displaced and assigned as a workforce to care for COVID-19 cases, reducing their availability to diagnose and treat chronic disease.
Throughout this time, screening is still an essential aspect of healthcare. Efforts are made to keep our population healthy and spot cancer before it’s too late. But the volume of urgent cases due to COVID-19 and the emergent regulations to stop its spread have taken their toll.
Moreover, even if doctors and patients finally meet and try to reach a diagnosis, studies also showed a disruption in the supply chain. Imaging equipment, technical maintenance, contrast substances, medications, and other medical supplies are often lacking. This problem was reported in 79% of the centers interviewed for this systematic review (1).
There was a report about high mortality in pediatric cancer due to delays in cancer referral. It was a case of 5 children who came to a hospital in the United States with negative COVID-19 tests. They were not diagnosed early and required resuscitation, intubation, and other life-saving interventions. Two of them died after a few days.
What was the reason for the delay? The family of one of these patients was reluctant to seek medical care. They were afraid of exposing themselves and their children to coronavirus. The family of the remaining four patients had sufficient contact with health professionals. But they were still not adequately diagnosed.
A variety of healthcare system problems were possibly playing a role (2):
Laboratories, emergency departments, and many specialists were unavailable.
Incorrect use of telemedicine
There was either an incorrect transition to telemedicine or resistance to this type of service. Using this type of service has its limitations, and both doctors and patients should be aware. Doctors are unable to detect pallor, hepatosplenomegaly, unstable vitals, and other cancer signs.
Signs of malignancy are often signs of COVID-19. For example, malaise, fever, and respiratory symptoms.
Delay in treatment
Having a drop in cancer referrals would not only delay the diagnosis. It will also delay treatment, sometimes to a late stage of the disease. Even patients with a clear diagnosis have had an interruption or obstruction in their treatment. In the systematic review mentioned above, there was also data about delays in treatment.
Out of 62 studies reported by these authors, 22 focused on treatment delays. Cancer surgery was delayed or reduced because of coronavirus in 16 studies. Radiotherapy delayed in 10 studies. Outpatient visits were canceled or rescheduled in 10 studies.
Medical procedures for patients with chronic diseases such as cancer have suffered disruptions from coronavirus for over one year. This reduces the number of chemotherapy sessions, the availability of surgery, radiotherapy, and other procedures.
The systematic review reported that 77.5% of patients experienced an interruption in different stages of their treatment. The reason patients were given is not only related to quarantine compliance.
It is not only because of social isolation or to minimize COVID-19 exposure. Instead, the efforts centered on attending to the most urgent cases and the highest volume of patients coming from COVID-related complications. In this regard, doctors were no more than following national or local guidelines.
Another cause was related to the medical supply shortage. 40% of patients in a medical center reported difficulty accessing their anticancer medications.
Similarly, 36% of modifications in chemotherapy regimens were due to medicine shortage. Even clinical trials and experimental cancer treatment reduced by up to 65% (1).
The problem is not as bad as canceling treatments or shutting down cancer care. However, patients face significant obstacles to treating their condition, and their tumors keep growing as time passes.
What you can do
It is possible to solve this problem but it requires efforts from the medical community and their patients. We’re going through difficult times, and it was not possible to predict all of the consequences.
So, instead of waiting for the end of the pandemic, it is better to start doing something about it.
Here’s a group of ideas from a recent research paper published in the European Journal of Cancer Care (3):
Understand there’s a risk of delay
By reading this article, you’re giving the first step forward. We all need to know that diagnostic delay from coronavirus is a possibility for cancer and other severe health problems.
In the systematic review cited above, most studies were in Italy, the United Kingdom, and other parts of Europe. Most data from the United States evaluated local was limited to a type of cancer or type of procedure. They should make thorough investigations to understand the burden of the problem.
Meanwhile, patients should be aware that the system is overwhelmed, and reaching a diagnosis could be more complicated than pre-coronavirus times.
Use telemedicine, but be aware of its limitations
The expansion of telemedicine is positive after COVID-19. It is a valuable tool, and we are encouraged to use it. However, both doctors and patients should know its limitations.
In cancer care, a thorough physical exam is necessary to find out what’s wrong. It is not possible to do that in telemedicine. The resolution of the device you’re using can also become a limitation.
Doctors won’t be able to give you an accurate opinion about lesions they are not fully able to see.
Talk to your doctor about these limitations and consider whether or not a face-to-face encounter will be necessary.
Don’t put off seeing a doctor
Since the pandemic, many people have put off going to the doctor. For example, since April 2020, over 58,000 men have begun prostate cancer treatment in England, but this number is 14,000 less than expected in comparison to pre-pandemic numbers.
Many men have told Prostate Cancer UK that they didn’t want to ‘bother’ their GP during the pandemic – particularly if they didn’t have many symptoms, which is often the case in patients with early prostate cancer.
This means that men who are at a higher risk of prostate cancer are missing crucial conversations with their doctor that can lead to a diagnosis.
The prognosis for cancer patients will be a lot better the earlier they get treated. It is important to understand that many patients often do not show symptoms in the early stages. Therefore, you should check your cancer risk factors and don’t delay seeing your healthcare provider.
Identify and deal with obstructions to healthcare access
Sometimes, the obstacle to healthcare access is founded on fear and apprehension. We think that hospitals are the epicenter of disease and do not want to be infected. This is reasonable but not a helpful thought if we’re letting chronic illness on its own.
Neglecting your condition out of fear is never a good idea. Doctors can also expand access to medical services making it more flexible for patients. Making it clear for patients and keeping in contact with the population is vital.
It could also be useful to set up temporary diagnostic sites with specialists. They would screen for cancer and other conditions without overcrowding medical facilities.
Understand your cancer risk
Patients with increased risk should have the upper hand in diagnostic procedures and workups. In this case, patients at risk are not only those with an environmental or genetic predisposition.
Patients who usually do not show up or postpone doctor visits should also be considered high risk. Placing extra obstacles will make them delay their treatment even more. Thus, doctors should create a system to detect “lost” patients and procure them. They should also tag patients with chronic disease, old age, and those who require extra attention.
Patients with cultural and language barriers also have an overlapping risk to consider. This is not only a doctor’s job.
Patients and their families should prompt high-risk patients in all of these categories to look for medical attention. Do not leave everything for a later time and do not support them in the idea of neglecting their condition.
Understanding the human body and the basics of health is essential in these trying times. This is health literacy, and it will be one of the tools against cancer diagnostic delays.
Patients should be informed about cancer, its risk factors, signs, and symptoms. That way, it is less likely that they will miss an emerging sign. For example, a painless breast nodule in breast cancer or chronic cough and chest pain in lung cancer.
Awareness campaigns to educate women about breast cancer have contributed a lot to reporting nodules. They jump the screening step and go directly with their doctor with concern.
Similarly, educating the population about cancer signs and symptoms is essential for an early diagnosis of cancer in our coronavirus reality.
Don’t forget about psychosocial needs
One of the aspects of cancer is how it connects to psychological aspects. Stress, anxiety, interpersonal and financial issues can contribute to tumor growth by affecting our immune system.
If you’re subject to significant stress, it is essential to find coping strategies to relieve tension. If you don’t feel stressed at all, don’t underestimate stress. Sometimes it is hidden under several layers of defense mechanisms covering it up.
Fear about COVID 19 infections should never become an obstacle to look for medical attention, especially if you have alarming signs.
As coronavirus cases increase and the efforts focus on treating these patients, the diagnosis of cancer and xother chronic diseases starts to decline.
Recent studies show a significant reduction in cancer referral, diagnosis, and treatment.
This is happening in the UK, the United States, Italy, and many other countries. In the long term, this leads to delayed treatment, advanced cancer stages, and more complications.
Even prostate cancer patients have experienced significant delays in prostate cancer treatment. This type of cancer is usually slow-growing, and it takes many years to develop obstructive symptoms in male patients.
However, prostate cancer screening is essential to detect cases before the tumor spreads to other organs, turning into advanced prostate cancer.
There are also cases of aggressive prostate cancer that do not follow the slow-growing pattern. They rapidly turn into a severe disease that requires radiation therapy and androgen deprivation therapy (hormonal therapy).
The recommendation is for males with urinary symptoms and risk factors for prostate cancer not to delay scheduling a visit with their urologist.
Telemedicine is an alternative to obtain an initial assessment and read your PSA test, but you may need face-to-face interaction and a physical exam in some cases.
For PCA patients with small prostate tumors, the recommendation is to keep in close contact with your urologist.
If you’re under active surveillance, do not miss an appointment and report any change in your urinary symptoms. If you have metastatic prostate cancer, you usually receive hormone therapy in oral medications.
Some chemotherapeutics can also be administered orally to avoid hospital visits.
Talk to your doctor about your available options.
Do not give up if you ever get a radical prostatectomy canceled or postponed. This has happened to other cancer patients throughout this challenging time.
Find out about Herd Immunity and What It Means for COVID-19.