Many proceedures have been postponed because of the pandemic Photo: AFP/File

A month delay to cancer care might raise death risk: study

By Kelly MacNamara

Delaying cancer treatment by just a month can put patients at a sharply greater risk of dying, according to research published Wednesday, the latest to sound the alarm over the coronavirus pandemic's impact on other health conditions.

Treatment delays happen in normal times, but the spread of COVID-19 has caused unprecedented disruption to healthcare services.

In a new study published in the BMJ medical journal, researchers in the UK and Canada found that delays in treatment -- whether for surgery, radiotherapy, or other treatments such as chemotherapy -- for seven types of cancers had a significant impact on patient mortality.

"There has never been a systematic attempt to look at all the evidence on what delays in different types of treatment mean for cancer patient outcomes," said co-author Ajay Aggarwal, a clinical oncologist and Associate Professor at the London School of Hygiene and Tropical Medicine. "Because we know this is happening to cancer patients during the COVID-19 pandemic it is essential to understand the real impact."

The study found even a one-month postponement could mean a patient had a six to 13 percent higher risk of dying. The longer the wait for treatment, the higher the risk.

The authors described the findings, based on dozens of international studies published over the last two decades, as "sobering".

The research suggests that "for the majority of the major cancers and treatments there is no 'safe' treatment delay", Aggarwal told AFP.

Researchers estimated that a delay in surgery of 12 weeks for all patients with breast cancer -- during COVID-19 lockdowns and their aftermath, for example -- would, over the course of a year, lead to 1,400 excess deaths in the UK, 6,100 in the United States, 700 in Canada, and 500 in Australia.

Many hospitals with major coronavirus outbreaks were initially forced to postpone non-emergency procedures to avoid putting patients at risk.

In Britain, the researchers said a number of conditions were considered safe to be delayed by 10 to 12 weeks, including all colorectal surgery.

"Our study suggests that this is not the case and could in fact increase the risk of premature death by approximately 20 percent. A similar duration of delay for bowel cancer chemotherapy could increase the risk of death by 44 percent," Aggarwal said.

He called for urgent measures to tackle backlogs and the use of alternative treatment methods for patients, such as "shorter but equally effective radiation therapies".

Researchers based their calculations on analysis of 34 studies, with data on procedures for cancers of the bladder, breast, colon, rectum, lung, and cervix, as well as the head-and-neck.

Overall, they found that a four-week delay in surgery increased the risk of death by six to eight percent.

There were even greater negative impacts for stalling other treatments, with a four-week postponement of some systemic treatments for colorectal cancer linked to a 13 percent increase in the risk of death.

Responding to the study, Justin Stebbing, Professor of Cancer Medicine and Medical Oncology at Imperial College London, said it was important to balance COVID-19 risks with those associated with delays.

He added that research he co-authored this month in the Journal of the National Cancer Institute suggested that hospitalized COVID-19 patients with cancer had a sharply higher fatality rate than those without cancer.

"This is a very complex, evolving and difficult situation as we clearly need to protect vulnerable cancer patients from COVID-19," he said in comments to the Science Media Center.

Ongoing research has suggested pandemic lockdowns earlier this year saw a slump in emergency room visits for things like heart attacks and strokes, while world health bodies are alarmed by the impact on the fight against HIV, malaria and tuberculosis.

In a study published in August in the journal JAMA Network Open, researchers found the number of cancers diagnosed weekly in the United States fell by almost 50 percent during March and April compared to recent averages.

© 2020 AFP

©2020 GPlusMedia Inc.

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A lot of people think that cancer is a slowly progressing disease that let patients and doctors plenty of time to consider options for treatment and their advantages, this is not true. Doctors usually pressure the patients to decide and undergo treatment as soon as is possible, because even a day of delay may lower the chances of recovery.

This is part of the reasons why is so important to control the pandemic and the number of cases, so hospitals can remain free and patients can deal with every other health problems without worrying about getting infected. The pandemic can cause death rates to increase also indirectly because of delayed treatment or even immunizations, that can cause outbreaks of other serious diseases.

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The scary thing about Canada, my country, where this survey looked, are long wait periods for patients for surgery, usually months. For cancer, it averages over a month.

In Japan, I'm in and out of a clinic in an hour, without an appointment. My friends in Canada tell me they wait several hours. The system can't keep with the rapid population growth, especially in the cities. What's really scary is policymakers are vowing to inflate the population at an even higher rate. That will really put a strain on public health. No such problems in Japan, thank goodness!

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I became a cancer survivor this year from prostate cancer. Wan't detected until last year, lack of testing with the only option of removal. Caught earlier might have had other options. I have a da Vinci or robot op which was a better than the traditional surgery methods. I went home after 7 days. Extensive full body MRI's revealed that the cancer had not spread to other parts of my body.

From the time of my cancer discovery to having the operation and visiting three hospitals my treatment was excellent and I don't have a single complaint. I felt lucky to be in a country which have the necessary equipment, MRI, CT, robots for keyhole surgery and great people to do the job. My care from the doctors and nurses was amazing.

I had the great fortune to get everything done by February before the Covid-19 really hit and stopped many treatments and operations.

I still need hospital visits every three months for further testing.

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