Surgical delays due to COVID-19 could lead to shorter life spans for cancer patients: study

Dr. Richard Whitlock operates in this undated handout photo. HO, Hamilton Health Sciences / THE CANADIAN PRESS

Longer wait times due to the slowdowns of cancer surgeries during the COVID-19 pandemic in Ontario will likely lead to decreased long-term survival for many patients with cancer, a new study has found.

As the province quickly pulls back pandemic restrictions and the health-care system steams ahead, a research paper published in the Canadian Medical Association Journal on Monday revealed the impact of the Ontario government’s decision to reduce the number of cancer surgeries, along with other elective surgeries, performed in the province during the first COVID-19 wave.

“This research paper used real world data, combined with a simulated model, to demonstrate that delays in surgery in our health-care system in Ontario are likely going to lead to changes in survival for cancer patients in the future,” said Dr. Tony Eskander, a surgical oncologist at Sunnybrook Health Sciences Centre and a lead author of the report.

The province’s decision to reduce the number of elective surgeries was made in anticipation of a potential surge of patients with COVID-19. The study states that while necessary at the time, the strategy resulted in a backlog of cancer surgeries, and some patients faced longer wait times for surgical treatment.

The study focused on patients receiving non-emergent cancer surgery in Ontario. It included patients with breast, gastrointestinal, genitourinary, gynecological, head and neck, hepatobiliary, lung and prostate cancers.

The study uses a microsimulation to analyze the long-term consequences of the pandemic-related surgical delays. It looks at the 22,799 patients who were waiting for cancer surgery before the pandemic, and then looks at the waitlist of 20,177 patients during the pandemic, and the research team subjects them to different wait times.

“We subject them to what the regular wait times are, which on average prior to the pandemic, was about 25 days, and then the pandemic wait times, which on overage when the pandemic started was about 32 days,” Eskander said.

“Seven day difference seems like a very small difference, but when we took those patients and we put them through out health system in the model, we identified that those additional waits actually led to changes in survival.”

Eskander noted that all patients with cancer in Ontario, overall, lost a combined 843 life years due to surgery delays in the first wave of the pandemic.

“And, we only really modeled the first wave. We only really focused on the first six months of the pandemic so that number is probably much greater because we have subsequent waves with subsequent slowdowns,” he added.

The study also highlights that the results reported in the research paper are likely conservative estimates of the true impact of the COVID-19 pandemic on outcomes of patients with cancer.

The study noted while de-escalation of cancer surgeries during pandemics may be required, the slowdowns are associated with a risk of “unintended harm.”

“Careful management of health-care resources is critical during times of resource constraint to mitigate unintended consequences,” the study concluded.

Looking at the big picture, Eskander added the Ontario government should focus on a “holistic approach” that builds capacity in the health-care system, such that “even when our health-care system is pressed, we have the ability to continue with life saving and absolutely needed surgery.”

“In reality, in Ontario, our hospitals prior to the pandemic were already running at 100 per cent,” he said. “We're still stuck trying to catch up and prioritize patients … What we really want to do is to create capacity in the system, where patients who need surgery should have free and open and equal access to it.”

“The only way to do that is to build more hospitals, build more operating rooms and provide more access to surgery in the health-care system.”

CANCER DIAGNOSIS FALLING THROUGH THE CRACKS

Eskander stated that another issue recognized in the study is many individuals are not even getting their cancer diagnosed in the first place due to pandemic-related issues.

“We're behind even on picking up on cancers and even getting them through to treatment,” he said. “We know that there's a number of cancers that are being diagnosed at a far lower rate than we would expect from prior to the pandemic.”

He said that often times cancers are diagnosed by accident on scans, including CT scans, MRIs and ultrasounds, but during the pandemic this imaging was not used as frequently as before due to disruptions in the health-care system.

He added that screening programs, which are meant to pick up on cancers during an early phase, were also disrupted during the pandemic.

“We still have a backlog. We haven't quite caught up on our screening, but presumably as we catch up, we're going to have a massive wave of cancer patients coming through the system,” he said.

Eskander added the final, and probably most important reason why cancer diagnoses are not happening as often as usual, is the lack of in-person medical appointments.

“I think virtual care is important and it's here to stay, but I think seeing physicians virtually only, or predominantly, is a problem,” he said. “Because a lot of cancers that otherwise would be seen by a physician or felt on physical examination are missed and caught at a later time.”