'Collateral damage': Doctors worry patients diagnosed with more advanced cancers because of delays
TORONTO -- Back in March, Bill Gardner’s doctor wanted him tested for a sore throat, trouble swallowing and a slightly altered voice, but couldn’t get an appointment because of delays from the coronavirus pandemic.
It wasn’t until Gardner coughed up blood four months later that he got checked out. He had Stage 2 oropharyngeal cancer.
The epidemiology professor at the University of Ottawa is among the thousands of Canadians who researchers believe will present to doctors with more advanced cancers because they have to wait longer for tests.
“To some degree, the cancer is bigger than it would have been found earlier and so I’m going to have to have more intensive radiation,” Gardner told CTV News.
“I am -- to some degree-- collateral damage. It doesn’t necessarily mean it’s anybody's fault, but that’s a good way to describe my situation.”
Gardner has been documenting his experience with cancer during the COVID-19 pandemic in a personal blog and hopes that coming forward will lead to better provisions for cancer patients in the future.
“It's time to think through the policies … that have reduced access to primary care, that have reduced access to diagnosis and screening (and) that have made it more difficult for people to get out-patient care,” he said.
In Canada, an average of 617 people are diagnosed with a form of cancer every day, according to the Canadian Cancer Society.
One of the big keys to surviving cancer is an early diagnosis of the condition, but with appointments suffering widespread cancellations back in the spring, the full scope of the pandemic’s impact may not yet be known.
“Some people who might have gotten early treatment that could save their lives might not have their lives saved,” Gardner said. “Some metastases from those cancers that might have been prevented by earlier treatment will happen and more demanding -- and frankly toxic -- treatments will have to be used.”
Dr. Antoine Eskander, a surgical oncologist at the Sunnybrook Health Sciences Centre in Toronto and adjunct scientist at the Institute for Clinical Evaluative Science (ICES), believes there has been a 20- to 50-per-cent drop in cancer surgeries due to the COVID-19 pandemic.
“I can tell you as a scientist and as a surgeon I'm seeing the impact of it in the data,” he said.
“Delaying the diagnosis … has led patients to come in with larger tumors. More emergency surgery or add-on surgery, as opposed to elective or booked surgery, because people are presenting at a stage where they absolutely need an emergency procedure.”
Eskander is working on three studies with the ICES to examine how delays in cancer-related appointments impact Canadians. His work will follow similar research already conducted around the world that estimates thousands of people will die from cancer due to delays associated with the COVID-19 pandemic.
Last week, a study in the Journal of the American Medical Association reported that weekly diagnoses of breast, colorectal, lung, pancreatic, gastric, and esophageal cancers dropped 46.4 per cent during the pandemic.
“There was a dramatic decrease in the number of people that we identified as having six common types of cancer,” said Dr. Harvey W. Kaufman, the medical director of Quest Diagnostics. “There’s a 46 per cent decline in the March-April time period, which means that these people didn’t get their screens and tests during those early months of the pandemic.”
The study notes that the Netherlands and the United Kingdom have also reported similar declines.
“While residents have taken to social distancing, cancer does not pause,” the researchers wrote in the study. “The delay in diagnosis will likely lead to presentation at more advanced stages and poorer clinical outcomes.”
Another study meanwhile suggests the U.S. may see 33,890 excess deaths in the next year due to delays in cancer diagnoses.
In the U.K., a similar study estimated as many as 3,621 more people could die from breast cancer, colorectal cancer, oesophageal cancer and lung cancer within the next five years due to delays in diagnoses.
“Urgent policy interventions are necessary, particularly the need to manage the backlog within routine diagnostic services to mitigate the expected impact of the COVID-19 pandemic on patients with cancer,” the report states.
While similar data is not yet available in Canada, Eskander believes the situation in Canada will be clearer in the coming months.
“My hope is that within the next month or two that we will have fairly accurate data at least for March and April, something that we can really hang our hat on and say: ‘Listen, this is what happened,’” he said.
To address the situation in Canada, Eskander is calling for urgent planning and additional funding to address the consequences of these delayed diagnoses. He hopes doctors will allow for more screening for cancer through telehealth and to avoid closing all hospitals to cancer surgery and diagnosis in the event of a second wave.
“COVID isn't going anywhere, anytime soon, and neither is cancer,” he said. “We need to find a way to work within the confines of a pandemic to provide the best possible care for our patients.”
Eskander said doctors need to increase their efforts to catch up on delayed cancer appointments.
“There is no doubt in my mind, we are going to find more advanced cancers, and a delay in diagnosis, but eventually a back log of cases that require treatment,” he said. “We're already seeing evidence of that it's very obvious to all oncologists.”
Gardner agreed that it’s time to adjust policies to better treat people with cancer.
“Canada has done an excellent job, by and large, with the pandemic and now it's time to assess how well we're doing and see if we need to recalibrate our policies,” he said.
“It could be that it's really time to now supercharge our efforts to catch up on things like cancer care, to catch up on vaccinations for children, and various things that I feel -- to some degree -- went by the wayside as we were trying to cope with COVID.”