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“A tumor that advances without treatment reduces the window of opportunity, limits the purpose of the treatment itself, since it can go from being curative to palliative, and negatively affects the patient’s later quality of life”, emphasizes Dr. Ignacio Gil Bazo, co-director of the Department of Medical Oncology at the Clínica Universidad de Navarra at the headquarters of Pamplona.
In light of the latest data published at the end of December by various institutions, such as SEOM, SEOR of AECC, which shows a 21% decrease in the diagnosis of new cases between March and June 2020 due to the effect of the pandemic, co-directors of Medical Oncology at the University of Navarra Clinic they reflect on the World Cancer Day, on the impact of this delay in diagnosis in cancer patients.
“Every tumor is born in a specific organ in isolation and, if it is not treated, it progresses. It is not the same that the patient begins with symptoms and seeks help in March to do so three months later, “adds Dr. Antonio Gonzalez, co-director of the Department at the headquarters of Madrid.
In the middle of the third wave, both specialists explain that we will have to wait to know what the global consequences will be, after a year marked by the pandemic: “The 21% decrease in new diagnoses is limited to March-June 2020, we will need new studies to know what the real impact has been, but it is reasonable to think that by the end of the third wave we will be around 30% ”, explains Dr. Gil Spleen.
“From March to June, everything stopped. But in the following months, many people continued to be afraid and have avoided leaving their homes and going to hospitals. Not only in the case of having any symptoms or changes in the body, but they have stopped screening for tumors as prevalent as breast, colon or lung cancer. And we will know the effects of this delay in the future, “he says.
Postponing diagnosis does not only influence the cure rates of a disease as prevalent as cancer (each year they are diagnosed in Spain around 275,000 new cases and the incidence continues to increase), but also in those patients who, despite not having a curative treatment, can slow down or chronify the development of the tumor. “During the confinement, many patients came to the Clinic after having symptoms for several weeks and without having been able to complete the diagnostic tests or begin treatment. In this way, we had to speed up the tests and the obtaining of the results and thus be able to make up for lost time, ”says Dr. Gil Spleen.
Faced with this situation, the processes had to be adapted to continue caring for cancer patients who were in the process of diagnosis, treatment and follow-up. “We have accessed technologies such as telemedicine in an accelerated way and we have designed circuits and protocols to protect patients and continue in the fight against cancer, despite the Covid”, says Dr. González.
In order to protect patients and professionals, processes have been activated to reduce hospital visits and establish safe circuits. To do this, the implementation of telemedicine was accelerated, with two aspects: telephone consultation or video consultation, depending on the case, for patients, and multidisciplinary clinical sessions by videoconference. Remote care also allowed the establishment of telework shifts, minimizing risks and guaranteeing continuity of care, in the event that other professionals test positive.
With the passage of time, the greater knowledge of the behavior of the virus and its forms of transmission allowed the establishment of independent circuits within hospitals that guarantee safe care for non-Covid patients. The need to maintain a safe distance has led to the reorganization of consultation schedules, extending the hours and reducing the number of patients / hour.
This, in addition to hand hygiene measures and the use of masks, screening in the access to the hospital and the implementation of massive tests, generalized throughout the hospital.
In this sense, both specialists encourage the population to contact their doctor in the event of any new symptoms in order to address the disease as soon as possible. “Oncologists are prepared to continue treating cancer patients,” emphasizes Dr. González.
Research: economic crisis and polarization of resources
The consequences of the pandemic are not only affecting current cancer care, but the future of oncology may also be compromised. Advances in recent years have changed the way of diagnosing, with more early detection programs, and improved and developed new treatment modalities with greater curative options and less toxicity.
“A progress in which research has been, and continues to be, an essential piece. However, the confinement, the economic situation and the resources allocated to research on Covid-19 have had an impact on the research work of many centers ”, highlights Dr. Antonio González.
“During the first wave, the confinement led to the closure of the research centers, where there were many difficulties to be able to work normally. In addition, at a certain moment the resources and competitive research calls have focused on Covid-19, so that there has been a decrease in the availability of resources oriented to research in cancer or other pathologies that were here before coronavirus and that, when it happens, they will continue to be, ”says Dr. Gil Bazo.
In this way, the pandemic has seriously jeopardized therapeutic innovation in cancer, due to the limitations in resources and the extra difficulties in the implementation of new treatment programs. “At the Clinic, for example, in the middle of the pandemic in April, we had to overcome all the challenges derived from the pandemic in order to open the Proton Therapy Unit at the Madrid headquarters so that patients could benefit from this therapeutic innovation “, remember.
Likewise, clinical trials have also seen recruitment processes reduced and even closed. Many hospitals have not had the possibility to continue treating these patients in the acute phase since all the assistance, in terms of personnel and physical spaces, had to be allocated to the treatment of patients infected with SARS CoV-2. “However, after this phase, all promoters, regulatory agencies and researchers made an effort to adapt to the situation that clinical research did not stop. An example, in the Clinic 60 trials were opened in the last year, and in the previous year 36. We have generated protocols that make research and monitoring safe ”, says Dr. González.
About the University of Navarra Clinic
With more than 2,800 professionals in exclusive dedication at its headquarters in Pamplona and Madrid, the Clínica Universidad de Navarra is an academic hospital, a benchmark in personalized medicine in our country. Recognized for its research and teaching work, the prestige of its professionals and its trajectory in the diagnosis and treatment of highly complex pathologies, the Clínica Universidad de Navarra is a high resolution hospital, due to its rapid diagnosis thanks to its multidisciplinary work and the acquisition of the latest technology, to offer care in 46 medical and surgical specialties.
The Clinic is among the 50 best hospitals in the world, according to the Best World’s Hospitals ranking, and among the 35 best cancer hospitals in the world according to the Best World’s Specialized Hospitals ranking, and for the sixth consecutive year, it has been the private hospital with the best reputation in Spain (according to the MRS ranking).
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