Backlog in screenings causes influx of patients with advanced cancers, says Ontario doctor
Screenings for breast, cervical and colorectal cancers were put on hold in March to deal with pandemic
Dr. Jonathan Irish says the backlog of elective medical procedures caused by the COVID-19 pandemic has contributed to an increase of patients putting off going to the hospital until their conditions have worsened — including advanced cases of cancer.
The head and neck surgeon, and provincial head of the Surgical Oncology Program at Ontario Health, isn't the only one who's noticed this.
Doctors across Ontario spoke to the Toronto Star about the effects the pandemic has had on cancer screening, treatment, and surgeries in the province.
In mid-March, Ontario put screening programs for breast, cervical and colorectal cancers on hold in an effort to pool more available resources to deal with the pandemic.
According to data shared with the Star by Ontario Health, there was a 97 per cent decrease in screening mammograms (4,065 from 158,967), an 88 per cent decrease in Pap tests (26,269 from 219,079) and a 73 per cent decrease in fecal tests (38,000 from 141,251).
It's not just affecting Ontario. In April, CBC News estimated that close to 100,000 patients across Canada had their surgical procedures delayed due to COVID-19.
Irish spoke to As It Happens host Carol Off about the effects the backlog has on patients and the health-care system, and what to do as many parts of the country are embroiled in a second wave of COVID-19. Here is part of their conversation.
Dr. Irish, how much more advanced are the cancers that you're seeing in some of your patients?
That's really hard to measure. We have 14 regional heads throughout our province for cancer surgery and we're hearing from the ground that patients are presenting with more advanced disease.
So I can speak personally as a head [and] neck cancer surgeon, and in my unit that we've done 10 laryngectomies. Now a laryngectomy is an operation done for the most advanced voicebox cancers, or larynx cancers. And we've done more in the last two months than we usually do in a full year.
Now, that's anecdotal. But we're hearing from our colleagues and from the ground that patients are presenting increasingly with more advanced cancers. And, of course, that has implications, meaning more advanced surgery, longer surgeries, longer stays in hospitals — and, of course, implications for all sorts of post-operative care, including radiation and chemotherapy.
Is it your sense and the sense of other doctors — again, this is anecdotal — that this is linked to the pandemic?
I don't think there's any doubt. So we know, for example, that patients are visiting their primary care doctors less often. We know, in fact, that the number of CT scans and MRI scans that have been done in the province is a lot less than the same time last year.
Our screening programs for colon cancer, mammography for breast cancer, our cervical cytology screening for cervix cancers and so on are down over 80 per cent.
And, of course, that pipeline, that diagnostic pipeline throughout the course of a patient's pathway through the system, from primary care to diagnostics and CT and MRI and screening, ultimately results in patients being slowed up in the diagnostic pipeline. And I conjecture that they're presenting with more advanced cancers.
Is it the choice of those patients who are not getting the pre-screening, or not going to see their doctors just for routine things [or] if they feel there's something that they should get looked at … or is it that the system isn't allowing them in?
I think it's a little bit of both. So I've been on situations, and I know my colleagues have as well, where I've had patients who have been diagnosed with cancer but are fearful of coming into the hospital for care. Because they are fearful, quite frankly, that they're going to contract … COVID-19 while they're in hospital.
And so I think there's an element here of fear of going to the doctor, of going to the hospital and, of course, of increasingly ignoring their symptoms so that they present with more advanced cancers. So there is an element of the system.
The chief medical officer of health directed elective services to shut down on March 17th of this year and opened up in May. And we're still seeing a backlog of patients as we wrap up our services.
We certainly proved that we could slow down quickly to create capacity for COVID-19 patients. But it was much more of a challenge to ramp up after we were directed to slow down services to create that resource for our COVID-19 patients.
As an oncologist, what does it mean to you and your colleagues that after all the years that you have put into trying to encourage people to get screened, to get looked at, to be in routine screening processes, all these things in order to have early diagnosis, that was just a key part of the success of cancer treatment, how much of that have you lost in this period?
It's hard to exactly tell you how much we've lost. But how do we feel? We feel frustrated, obviously. Whether we're a cardiac surgeon [or] whether we're a cancer surgeon … the ability to detect cancer early in its stages is absolutely critical.
And one of the ways we've been able to push the needle for improvements in cancer survival over the last 20 years — a huge part of that — is early detection and screening.
We're about to go into, or perhaps we already are into in many parts of the country, this second wave. What advice do you give to people who are hesitating about getting a screening?
I hope that the message will get out to our patients: Don't ignore symptoms, don't ignore symptoms of cancer, and don't ignore symptoms of cardiac disease or stroke and so on.
The other part of this is rather than reactive, which is to clear our backlogs of surgery, is to be proactive. So we know more about COVID-19 than we did last March. And so we understand that it's more of a regional pandemic, that we can react regionally with regards to how health-care services should ramp down to take care of COVID-19 patients, and how we can ramp up safely and protect our patients who do not have COVID-19, but care for them in a COVID-19 environment.
So we understand that we don't have to take a mass-casualty type of approach, where we closed down services like we did in March, to create a capacity of care for patients. We now understand that we can be much more selective in how we create resources for patients, and it's in response to how the regional uptick in patients who have COVID-19 is occurring.
Written by Jonathan Ore. Produced by Katie Geleff. Q&A edited for length and clarity.