COVID Disruption: Slipping Through the Cracks

One of my greatest fears is that I will get a recurrence of my ovarian cancer as an unprecedented global pandemic continues to inundate hospitals and limit medical services. COVID-19 has really made a mess of healthcare across the board—not just in Canada and the United States, but for the entire world. Elective surgeries have been cancelled, meanwhile family doctors and oncologists are only seeing their most urgent patients. To minimize the risk of infection, cancer clinics and family practices are using virtual appointments whenever possible.

Perhaps the most distressing thing to me is that cancer treatment has lost its sense of predictability and continuity. The way doctors and health care teams are treating cancer continues to change day by day as the coronavirus pandemic unfolds. Because this is wholly uncharted territory and protocols don’t exist, surgeons are considering data from previous studies to guide their treatment decisions. 

For example, in some cases this means changing the order of treatment and administering cancer medicines before surgery. Ovarian cancer is typically treated with surgery first, but since elective surgeries are on hold at many hospitals, some oncologists are choosing to start patients on chemotherapy. “We’re fortunate to know from prior research that the order of those doesn’t matter, that the outcomes are similar even if a patient starts with chemotherapy,” one prominent oncologist explained.

Chemotherapy, though, poses its own set of risks and challenges because it can compromise a patient’s immune system. During the COVID-19 pandemic cancer specialists have to be very thoughtful and careful about the type of chemotherapy they recommend. Fortunately, in most cases there are various treatment regimens that may decrease the risk of immune suppression, and oncologists can also alter the chemotherapy doses as they deal with an unprecedented situation.

According to leading oncologists, the easiest patients to handle at this point are those who are in remission and are just being watched. In those cases, patients connect through teleconferencing, which allows doctors to get a sense of a patients’ general well-being, to interact, and discuss how they’re doing. While this approach eliminates the risk of infection, the majority of cancer patients argue that virtual appointments are not the same as having a doctor who can see you in person, actually measure your temperature, and actually feel any lumps or bumps that you may be experiencing.

The next group, which faces more challenges, is chemotherapy patients. Doctors say people on chemotherapy are the ones that they are the most worried about, because they know the patients have cancer and they know that the window to treat that cancer is fairly limited. Personally, I am extremely grateful that I’m not among the thousands of women with ovarian cancer undergoing active treatment. At most cancer centres patients are still getting chemotherapy, but their oncologists are having them essentially go right from their home to the lab to the chemotherapy suite to avoid coming into contact with as many people as possible.

This routine is very stressful for patients and their caregivers because at most centres social distancing measures are in place that prohibit friends or family members from being in the treatment area. Rules can change almost weekly or with very little notice.  Leading cancer centres acknowledge that their protocols will continue to be adapted throughout the pandemic as circumstances change.

Newly diagnosed patients who may require surgery are another major concern for oncology teams. One oncologist said that the most challenging are the diagnoses where someone comes in with findings that are suggestive of ovarian cancer, but unconfirmed. Sometimes a benign tumor can appear quite abnormal on a scan, and can look quite like cancer. The oncologists have to decide about whether they should bring that person to surgery. Obviously, the operating room is another area where patients are compromised or at risk. Furthermore, surgical procedures require a ventilator, which means the hospital is short one ventilator for another individual who may need it.

These are very tough decisions for doctors. They want to make sure that they’re not putting off the actual ovarian cancer patients a lot more than necessary, but they’re also not taking every single mass that probably is benign to the operating room. And while there’s some notion that specialists can just say, “that’s probably the right call, or that’s probably wrong” … it’s a much trickier discussion. Sometimes I ask myself if what cancer surgeons or decision makers are being forced into doing is gambling with somebody’s health and, potentially, with their life.

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