Few events of the last century have shaken us from our comfortable lives the way the COVID pandemic has. Between government lockdowns and, for many, the paralysis of fear, normal life has been put on indefinite hold.
This February, to mark National Cancer Prevention month, pharmaceutical giant AstraZeneca, along with eight global coalition partners, unveiled a new campaign to raise global awareness and create a pathway for people to get back to standard cancer care services. In Canada, the campaign is supported by cancer researchers and oncologists from more than two dozen healthcare organizations.
“When the pandemic began, our healthcare system went into acute crisis response in order to limit COVID-19 transmission, but the ripple effect it has had on cancer care is alarming, and we are already seeing the profound impact,” says Dr. Shady Ashamalla, a surgical pncologist and assistant professor at the University of Toronto. “Delays in diagnostics, evaluation, and treatment can lead to more advanced cancers, limited therapeutic options, and access to clinical trials, and ultimately lead to poor patient outcomes. That is why it is absolutely critical that patients don’t wait. We are urging those with cancer or possible cancer symptoms, or even routine screenings, to re-engage with their healthcare team for the care they need.”
It’s estimated that approximately 225,000 Canadians would have been diagnosed with cancer in 2020, were it not for the pandemic. Looking back now, we can see that the actual number of diagnoses were significantly lower than that.
Many healthcare professionals believe that the pandemic is directly responsible, and they’re warning that the prevalence of cancer isn’t any lower despite the lower number of official diagnoses. In many cases, cancer just isn’t being caught in time.
“In recent months, I have had patients whom I have advised to seek urgent medical attention at the emergency department due to cancer symptoms or side effects from their treatment, but they have expressed extreme reluctance to do so due to concerns about being exposed to COVID-19,” says Dr. Winson Cheung, a prominent oncologist and the principal director of an organization called Oncology Outcomes. “Prior to the pandemic, there would be no hesitation to seek care at the hospital. I can empathize with their anxiety, but not going to the hospital when medically needed can result in serious health consequences.”
According to recent data, it is estimated that the number of newly diagnosed cancer cases over a three-month period in 2020 was down by 16 percent compared to 2019. Bladder and ovarian cancer diagnoses may be down by as much as 25 percent. Breast, prostate, lung, and colorectal cancer diagnoses are estimated to be down between 12 to 19 percent.
At the same time, some oncologists across the nation are reporting up to a five percent increase in late-stage diagnoses compared to 2019, suggesting that some cancer cases are being allowed to progress too far.
“These numbers are preliminary estimates and, as more data is gathered, it could be much higher in the near future if we do not reverse this trend,” Dr. Cheung says. “It also takes time for the healthcare system to see the true impact of COVID-19, so we may see more poor outcomes in another year. To intervene at that point is often too late and it means many more patients would suffer. This is what we are trying to prevent and why it is so important for Canadians to understand the impact of a delayed cancer diagnosis.”
He adds that hospitals and cancer care clinics have worked hard over the past months to reduce the risk of COVID-19 transmission through vigilant cleaning and monitoring, reducing waiting room capacities, and by ensuring that masks are worn by staff, visitors, and patients alike.
As well, Dr. Cheung adds that many healthcare professionals have learned to incorporate virtual care through online appointments, further reducing their patients’ risk of exposure.
A Local Diagnosis
Angela Pelletier of Niverville resident understands the anxiety that comes with facing cancer treatment during a pandemic.
Pelletier was at work the day she received the fateful call from her doctor in November 2019. At just 38 years of age, she’d been diagnosed with bladder cancer. She immediately went home to break the news to her husband, Nicholas.
“My husband was in shock,” Pelletier says. “Tears and hugs followed the news. I had to take care of him the first few days, but as the days unfolded and a plan was put in place, it did get easier. I had to remind him sometimes to take it day by day as his mind went to the future and the what-ifs. But with cancer, you cannot think that way. Facing each day with positivity and strength is all you can do and is the only thing you can really be in control of.”
Pelletier’s cancer treatments began in January 2020 with the surgical removal of tumours from her bladder. Family members were encouraged to accompany her for support at her appointments.
In April, as the province went into an aggressive pandemic response, Pelletier began a series of weekly BCG treatments, an immunotherapeutic approach used to treat early-stage bladder cancer. Over the course of two and a half hours, a drug was administered directly into her bladder.
From this point on in her cancer journey, Pelletier was required to attend appointments alone.
Over the course of the coming months, Pelletier also underwent numerous cystoscopies, biopsies, and CT scans. She also faced a total of four more surgeries.
“Even when the province went into lockdown and surgeries were being cancelled, I was never sidelined and my health was made a priority,” Pelletier marvels. “I received wonderful care from Open Health Niverville all the way to my healthcare team at Cancer Care Manitoba. I believe that my high-grade aggressive tumours and my young age may have contributed to this.”
Ferg Devins, chairperson of Bladder Cancer Canada, says that the experience of cancer patients across Canada may have varied during 2020, depending on how well each treatment centre was able to adapt to the challenges presented by COVID-19.
Devins adds, however, that he is unaware of any patient who was denied treatment for acute cancer.
For Pelletier, only one kidney scan had to be temporarily postponed during the spring lockdown period.
“Cancer is very scary,” Pelletier says. “Although COVID can be scary as well, having cancer far outweighed the risks of getting COVID. I followed all the precautions. I wear my mask, practice excellent hand hygiene, and everything that comes into my house gets properly sanitized before being put away. We are not taking chances.”
Outcome Could Have Been Worse
What Pelletier is sorry to lose out on are the emotional and social supports typically available to cancer patients in Manitoba.
“When I was first diagnosed, I was told there are support groups, including yoga and other programs to help cancer patients keep up their quality of life,” says Pelletier. “Unfortunately, this type of care did get cancelled. While online programs were put in place and more virtual programs were created, it really isn’t quite the same as having those face-to-face connections. But this is the world we live in now and safety is the first priority.”
More than a year after her diagnosis, Pelletier’s cancer journey is far from over. The early treatments proved ineffective and the cancer advanced into the muscle of her bladder.
Currently undergoing chemotherapy, Pelletier will soon be faced with additional surgeries to remove her bladder, uterus, urethra, and a number of lymph nodes. At that point, surgeons will redirect her urinary system to a urostomy pouch worn outside of her abdomen.
Based on her own experience, Pelletier strongly encourages people not to let COVID-19 stand in the way of getting an early diagnosis and care.
“It is very important to pay attention to any changes in your body,” Pelletier says. “I encourage everyone to see their doctor regularly and build a relationship. I was very fortunate to have a great healthcare team that sent me for the appropriate tests to find my cancer at an early stage. Even though it has been a challenging journey, the outcome could have been far worse if I didn’t have an open relationship with my physicians.”
