Many cancer patients have been stuck waiting for life-saving surgeries, according to a new study using Ontario data, confirming worries about the impact of the enormous and growing backlog of procedures caused by the COVID-19 pandemic.
And it’s not just cancer patients. Doctors are warning that the health care system has yet to return to pre-pandemic surgical rates, let alone clearing the backlog, with over a quarter of a million people in Ontario alone on standby for life saving operations.
The study, published in JAMA, showed a dramatic 60 per cent drop in cancer surgeries when the pandemic began a year ago, as hospitals reallocated resources like beds, ventilators, and medical staff to ensure they were prepared for a sudden influx of COVID-19 cases.
The result? Over 36,000 Ontario cancer patients had their surgeries delayed last spring.
“That’s a staggering number there and that’s in Ontario alone in a very short period of time,” said Dr. Antoine Eskander, a surgical oncologist at Sunnybrook Health Sciences Centre in Toronto.
“It’s almost impossible to recover from this type of a backlog … Even if we were to operate on Saturdays and Sundays and into the evenings every day, which we don’t have the capacity for, we could not do that even if we wanted to.”
Eskander says surgeries have only increased by small increments — about 6 per cent per week. To increase surgical capacity, it would require not just hospital capacity, but nursing and physician capacity as well. And even then, it would be hard to recover, he says.
“So we’re stuck in a situation now where I think it’s becoming clear we’re going to have to make decisions about surgery and about prioritization of certain types of procedures … And I’m worried that there will be some patients who won’t get surgery for a very long time.”
For one single mother, who asked not to be identified, the backlog has meant having her thyroid cancer surgery, originally booked for January after a diagnosis in November, postponed until March.
“Every time I clear my throat — is it COVID or is that cancer spreading? And that’s hard every day,” she told us.
“I often feel my neck, and it’s like, oh, there’s a lump there. Is that something that’s growing or is cancer growing faster than the doctors thought?”
The mental health impact of these delays adds another layer of stress for patients. When her surgery was cancelled, her son was heartbroken, she said, adding that the worry and the delays, combined with the pandemic has affected him in other ways too.
“I know everyday my life’s on hold,” she said.
Patients advocates say timely surgery for cancer isn’t optional — it’s essential.
“When you have a cancer diagnosis, cancer literally cannot wait. It’s progressive, it does not sit there and say, OK, we’ll wait till COVID is gone and then we’ll ramp up. it continues in the body,” said Diane Van Keulen, who was diagnosed in March of 2019.
She is at stage four lung cancer, and considers herself “one of the lucky ones”, pointing to the other lung cancer patients she knows who are at stage one or two and have had their surgeries cancelled.
“If you’re that patient being told your surgery is cancelled, knowing that you could be cured at that stage — that’s not okay. And the psychological stress that incurred on some of my friends was just unbelievable.”
A ‘TSUNAMI’ OF COMPLEX CANCER PATIENTS
Compounding the looming crisis are those who have put off medical attention over fears of catching the virus, and those who have faced delays with routine screenings and biopsies as well. Without a solution to expand capacity, this confluence of circumstances could create a deluge of cases, doctors warn.
“I think the major [issue] is what’s called diagnostic delay. So it’s delays between when someone has the first symptoms suggesting cancer and when they are diagnosed, or from the time that they would have normally been screened to the time they were diagnosed,” said Dr. Tim Hanna, an oncologist with Queen’s University’s School of Medicine.
“I’m worried that we’re missing our chance to catch cancer early, and to treat it early when really, that’s the best chance to cure the disease … If they feel unsafe to visit a practitioner or doctor in person, they should pick up the phone to start. We need to catch up on cancer screening.”
He and other doctors are anecdotally seeing more cases of advanced cancer, and more cases that require more complex management.
“It looks like a veritable tsunami of very complex cancer patients heading our way in a very dramatic fashion,” said Dr. Gerald Batist, director of the Segal Cancer Centre at the Jewish General Hospital in Montreal.
These are major red flags for oncologists who are urging strong public messaging for people to see a doctor if they have health concerns or if they are past due for a standard breast, colorectal, or cervical cancer screening.
“It’s very important that the … population understand that we have learned very well how to make the hospital environment very COVID safe … and so everyone should be coming for all of their scheduled screening tests,” said Batist.
“This is global, this is not Ontario, this is not Quebec, this is not Canada. This is happening all over the world … we knew this was coming. Everywhere in the world we’re seeing a very dramatic decrease in the number of cases that were diagnosed.”
There are no official plans to ramp up surgeries for cancer — or other conditions — that doctors are aware of. With cases mounting across the country, doctors are demanding a cancer recovery plan.
“It’s very alarming to us and we’ve all been working our hearts out the whole pandemic to just keep our cancer patients safe and keep treating them as best we could,” said Batist.
“This is a catastrophe for cancer care because this will have an impact on their survival.”
