There is no pause button for cancer. We can’t postpone, hold or reschedule it for a later date. But COVID-19 has forced an abrupt and immediate halt to crucial cancer screening, tests and treatments. While steps have been taken to gradually reintroduce routine and critical cancer care, we need to keep this momentum going – further delays and interruptions could ignite another public health crisis.
COVID-19 has created a deep disruption to cancer care, compromising safe and timely access to services and treatment. A survey commissioned in 2020 by the Canadian Cancer Survivor Network revealed that more than half (54 per cent) of Canadian cancer patients, caregivers and those awaiting confirmation of a cancer diagnosis had appointments, tests and treatments postponed and cancelled, triggering heightened fears and anxiety. Seventy-four per cent said these delays have had a major impact on their mental and emotional health.
“I’m concerned that we’re going to lose the great advances we’ve made in being able to catch cancers very early, or even when they’re pre-cancers,” explains Aisha Lofters, chair in Implementation Science at the Peter Gilgan Centre for Women’s Cancers at Women’s College Hospital. “We’re going to lose some of that benefit and may experience what many are referring to as a tsunami of cancer, where people are diagnosed at a later stage than they would have been. There may be significant consequences that trickle down from these delays.”
When COVID-19 first erupted, non-essential services, including routine cancer care, were put on hold. More than a year into the pandemic, these types of health services must be re-prioritized. With strict infection prevention and control protocols implemented in health-care institutions across the country, the likelihood of virus transmission during a cancer-care appointment is low. With services opening, it is imperative that patients feel comfortable and confident to connect with their primary-care provider for cancer screening, testing and treatment appointments.
“It’s our responsibility as physicians to continue reinforcing that it’s safe to come into the hospital or visit a doctor’s office, and then make sure that it truly is safe,” reiterates Lofters. “We need to resume cancer screening to reap the benefits of catching cancers and pre-cancers early before they cause significant harm. Although we have rightly put a great deal of focus on COVID-19 over the past year, other health problems have not been put on pause.”
The aftermath of this pandemic can’t be an afterthought.
COVID-19 has proved its endurance and longevity. A short pause can impact prognosis, but a delay of our current magnitude will have heavy consequences. The pandemic has reared full steam ahead – so too should cancer care.
Health-care needs, specifically cancer concerns, are more important now than ever. Cancer patients who experienced a cancellation, disruption or delay with imaging, biopsies, surgery, radiation or chemotherapy must re-book those appointments. Further delays could lead to severe health implications and irreversible long-term effects – undetected and untreated cancer can quickly become uncontrollable.
The long-term repercussions of COVID-19 on cancer patients remain blurred. To what extent will the disease have spread as the patient waited for treatment? How big will the backlog be for life-saving surgery? The aftermath of this pandemic can’t be an afterthought.
This pandemic triggered a seismic shift, disrupting the way health care and health services are provided in Canada and around the world. But we must resume proactive and reactive cancer care. Public health messaging and guidelines must continue amplifying that patient safety during the pandemic is top of mind. Canadians need to feel reassured that going in for a cancer care appointment will not put them in jeopardy, that instead the greater threat to their health would be to wait.
To avoid another major public health crisis, previously postponed or cancelled screening, testing and treatment appointments must ramp up – cancer care for Canadians can no longer come at the cost of COVID-19.
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Nice article Jaimie !
Here’s the thing – when the CPSO summarily shuts debate from its membership regarding these prolonged and draconian lockdown policies in Ontario, who is held accountable? How can these pointy-headed physicians at the provincial senior management table, CPSO, and regional public health authorities adhere to the “First do no harm” part of the oath yet by their actions predestine all these new cancer patients (that we comfortably know from epidemiology) to an earlier demise – let’s not quibble as we know the earlier the diagnosis, the better the outcome. It is truly shameful that physicians in Ontario (nay Canada) have been ‘muzzled’ in advocating for this patient population – for fear of getting called out and cancelled (by following their oath). According to Ontario provincial covid stats 28-Jun-21 three died from covid-19; StatsCan 2019 deaths from cancer ~290 per DAY. This comparison is not exactly apples to apples but it should present some thought provoking perspective. The curve has been flat for a long, long time – this was the reason for locking down.
Great article Jamie.
The tsunami of cancer cases coming our way means that the need for palliative care will be greater than ever. Unfortunately many of these cancers will be incurable and treatment will be aimed at minimizing symptoms and prolonging survival. But palliative care has been shown to improve quality of life, decrease stress and anxiety for caregiver and in some cases, even help extend survival.
Whether or not these individuals can access high quality palliative care will depend on where they live. Such is the postal code lottery for palliative care in Canada.