Well over a year into the pandemic, medical experts are worried about the potential long term health effects of missed cancer screenings.
As clinics closed amid concerns about the coronavirus, hundreds of thousands of tests and screenings were deferred. Now, the aexperts fear that this could delay critical diagnoses. As screenings are postponed, cancers are not discovered until they are more advanced. As a result, surgery has become increasingly common during the pandemic.
“We’re doing harder surgeries, on sicker patients,” Dr. Linda Ann Smith, a breast surgeon in New Mexico, recently told CBS News.
Experts predict the number of people who will die from breast or colorectal cancer in the U.S. will increase by nearly 10,000 over the next decade because of COVID-19’s impact on cancer care (National Cancer Institute).
Dr. Karen Finkelstein, who treats gynecologic cancers, has seen a 30% decline in cancer referrals throughout the pandemic. “I’ve been paralyzed by COVID because it’s changed the landscape of medicine and patients. You start to fear a sense of despair. The hurdles COVID has forced us to face this year — some of them have been insurmountable,” she told CBS This Morning, in a March 2021 report.
A vast number of patients have been left without access to recommended health care services, and this disruption to cancer screening services is likely to have a significant and longterm impact on patients, health care practitioners, and health systems.
In 2020, COVID-19 was the underlying or contributing cause of death for an estimated 345,323 people — nearly half the amount of cancer-related deaths, which came in at a staggering 598,932, according to the CDC.
To get a clearer picture of how COVID is affecting cancer care, we spoke to Dr. Jeremy Lorber at Cedars-Sinai Tower Hematology Oncology Medical Group.
Tower Cancer Research Foundation: What are you seeing right now in your own practice?
Dr. Jeremy Lorber: Anecdotally, I’ve seen patients who have signs or symptoms of cancer a year ago, now presenting in a much more advanced state than they would if they presented earlier. For the most part, with the more advanced presentation, it becomes harder to treat and less likely that treatment can be curative. It’s still a little early to know, but there have been some computer models to predict the outcomes — some studies out of England show that the mortality rates for certain cancers will increase because of delayed diagnosis over the last year or so.
What sorts of changes and adaptations were oncologists forced to make at the onset of the pandemic?
Like a lot of medicine, we tried to integrate telemedicine. We still use it, but for a lot of what we do, telemedicine is not adequate. The patients often need chemotherapy through an I.V., and that obviously can’t be done over telemedicine, nor can procedures like biopsies and scans. We were essentially limited in how much we could adapt; the treatment tools and the diagnostics had to remain as they were before COVID.
That said, we were able to adjust treatment a little off the standard pathways, because of COVID restrictions. We had a patient who, after several months of chemo, would have gone to surgery, but at the time, there were no operating rooms available. I had to give him extra chemo before surgery to buy him some time. We had to get creative — there was no playbook for this.
Did the pandemic change the way you interact and share information with other doctors and medical professionals?
The normal interactions between doctors of various specialties were very limited. The most fundamental, formal meeting we have in the field of cancer treatment is called the Tumor Board. Oncologists, surgeons, pathologists, and radiologists discuss difficult cases, especially difficult cases, and how to manage them. Usually, this was done in person, but throughout the pandemic, the meetings have been virtual. The interactions aren’t the same — they’re not as fluid. We lost all of the informal conversations that typically take place before and after the actual meetings, and thus all of the valuable epiphanies that come out of those conversations.
What were the most common fears among patients since the start of the pandemic?
We’ve been talking about delayed screening and treatment because of limitations on the medical side, like closures of clinics, but a lot of it was on the patient side. Even when tests or treatments were available to patients, patients can be their own worst enemies by being fearful and avoiding medical care. The obvious fear was that they’d contract COVID when they’d go to a doctor’s visit or chemo visit. They were afraid that they’d automatically develop COVID even though we were taking secure precautions. They would avoid coming in and fall off the map.
Were your patients worried about the safety of COVID vaccines?
For the most part, cancer patients I take care of were very enthusiastic about the vaccine — it was almost overwhelming. Every day I’d get multiple emails from patients. There were patients who had reasonable concerns, both regarding the safety and whether the vaccines would be effective given their medical status. The general recommendation from various societies is that patients with cancer are safe to get the vaccine. That said, there are some patients receiving certain treatments, for whom my confidence that the vaccine would be successful was low due to certain immunosuppressants. But if it had any efficacy whatsoever, it was worth taking.
As we emerge from the pandemic, are there new practices that you think will continue?
Telemedicine, which we didn’t use at all pre-pandemic, still plays a minor role, and not solely for COVID precautions. It opens up a more convenient way for certain patients to access their doctor. It’s something we learned from the pandemic as a new tool that might be continued.
What do you tell your patients when they come to you with COVID-related fears and anxieties?
I tell my patients a half-serious joke: you don’t want to let COVID get in the way of your health. You don’t want your fears and anxieties to be detrimental to your diagnosis. In some ways, COVID gave people an ‘out’ that felt very justifiable — a reason to ignore symptoms or put off appointments. I tell my patients that everything we do or don’t do has certain risks, and we just need to balance everything out. There’s no treatment or avoidance of treatment that is absent of risk. You might be able to 100% avoid COVID by staying home and not going to your doctor for a year, but that comes with its own risks.
This article was originally published in the Fall 2021 edition of Tower Magazine
Interview conducted with: Dr. Jeremy Lorber Cedars-Sinai Tower Hematology Oncology Medical Group