One year after the arrival of Covid-19, health experts assure that this context will cause effects in patients with oncological pathologies. In this note we tell you what those consequences will be.
On February 4, the Day of the Fight Against Cancer is celebrated around the world. This year, the pandemic produced by COVID-19 poses a scenario never seen before and with consequences that, in the medium and long term, seem not to be entirely clear.
It is a fact that the modifications that had to be made in the health system to deal with the pandemic significantly modified, at least initially, the way of accessing medical controls and initial evaluations to allow detection and treatment in patients who already had a chronic pathology.
The reality is that in the medical environment and today the consequences that these changes will bring, especially in patients with oncological pathologies, are largely unknown, but there are others that are already beginning to be glimpsed and that should be a matter of debate. Now, what will be the main effects of COVID-19 in cancer patients?
DESCENT OF EARLY DIAGNOSIS
During the pandemic, the diagnosis of cancer decreased to a great extent due to the decrease in consultations and screening studies in patients who had an increased risk of developing some type of tumor. According to some international publications, in the first months of the pandemic, consultations for breast, colon and cervical cancer screening decreased between 70% and 90% and although by mid-year a clear improvement was noted, they were still below normal values.
Dr. Sergio Quildrian. surgeon (MN 102.519), coordinator of the Oncology Commission of the Argentine Association of Surgery, maintains that, although there are different percentages for each type of tumor, “it must be taken into account that the screening methods (which are performed in patients asymptomatic, but with a high risk of developing oncological diseases) detect approximately 10% of adult patients who develop cancer, taking together the different types of cancer, the rest are due to medical consultations due to the appearance of symptoms ”.
Therefore, if we add the decrease or cancellation according to the time of the pandemic of the screening studies to the decrease in consultations, we are faced with a serious public health problem whose consequences will be seen in the post-pandemic or even in the coming months if the problem persists.
EFFECTS ON CONFIRMED PATIENTS
In a study from the United Kingdom on patients who already had a confirmed cancer diagnosis, it was observed that referrals and oncological treatments showed a decrease of 70% and 40% respectively at the beginning of the pandemic, with an improvement in May that, of anyway it did not equal what happened in 2019.
For example, a study in The Lancet reports that in April 2020 there was evidence of a decrease in referrals for colorectal cancer treatment, which then increased, reaching similar values in October than in 2019. However, it considers that 3,500 fewer diagnoses were made among April and October 2020 compared to the same period in 2019. This was partly due to the patient’s fear of consulting during the pandemic and, on the other hand, due to the limitations imposed in many institutions.
Meanwhile, a collaborative study of 356 centers in 54 countries identified the causes that contributed to the worsening of the management of patients with cancer pathology. They were: the decrease in the usual work rate, the overload of the care system, the shortage of personnel, the difficulty in accessing cancer drugs, among others (Journal of Clinical Oncology).
Now, the question that the medical community tries to answer is in what way the delay in the diagnosis of cancer (due to a reduction in the initial screening or consultation) and the interruptions of the specific treatments in patients already diagnosed can worsen the prognosis of cancer. disease.
Some reports suggest that the increase in mortality due to delayed care caused by the pandemic could be of the order of 5% to 16% in patients with different types of tumors, including colorectal, breast, lung and cancer. esophagus (The Lancet). Obviously, the negative impact generated by the pandemic can only be evaluated retrospectively, but the actions taken during it may, to a greater or lesser extent, modify the final results in terms of health.
THE HEALTH SYSTEM’S RESPONSE
Fortunately, most institutions quickly implemented protocols to allow the safest possible care in patients with pathologies that require active treatment or surveillance. It was possible to continue with the treatments in those territories with a low rate of cases, or modify it in areas with greater pressure on the health system. To this end, scientific entities quickly generated management guides to help professionals take behaviors with the least possible negative impact on the population.
An important fact is that telehealth, that is, the use of electronic means for use in health, presented a great expansion and without a doubt it is a modality that has come to occupy an important place in health systems, whether they are both public as private. Although it must be recognized that in our country these tools are not available in all places, they represent a solution in certain situations.
With regard to the last few months, there seems to be a greater openness to resuming medical consultations of all kinds, not only oncology. This attitude could reduce the impact in terms of survival or quality of life of patients with chronic diseases.
In conclusion and as is always stated by the Argentine Association of Surgery, those patients with chronic or oncological pathologies or who have an indication for screening should contact their family doctor or specialist in charge of their follow-up so that he can advise them on the behaviors to follow. In case of needing complex procedures, they should know that health institutions continue to operate with specific measures aimed at guaranteeing the safety of patients. It is important to note that any type of cancer detected early increases the chances of cure and a better quality of life.
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Advised: Dr. Sergio Quildrian. Surgeon MAAC. (MN 102,519). Coordinator of the Oncology Commission of the Argentine Association of Surgery. Sarcomas and Melanoma Unit- General Surgery Service of the British Hospital of Buenos Aires and Sarcomas and Melanoma Unit of the Ángel H. Roffo Institute of Oncology.
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