Tough Decisions as COVID Delays Cancer Surgeries
By Serena McNiff
TUESDAY July 14, 2020 (HealthDay News) – Many cancer patients experienced delays in their health care during the coronavirus pandemic, but with what consequences?
Researchers at the Beth Israel Deaconess Medical Center in Boston have analyzed 15 years of data to determine how long surgery for certain types of cancer can be delayed without compromising patients’ chances of survival. The study started in early spring because the pandemic led many hospitals to cancel or postpone elective procedures, including cancer surgery.
“We were concerned that surgeons and patients would be forced to make treatment decisions without a clear understanding of the risks,” said Dr. Scott Fligor, a general surgery resident who led the review.
From more than 2,000 articles published in the past 15 years, his team found 58 that studied the time between diagnosis and surgery in patients with colon, pancreatic and stomach cancers.
These studies have highlighted the importance of prompt treatment for colon cancer. Specifically, a delay of 30 to 40 days in surgery has been associated with poorer chances of survival. The same was true after delaying radiation therapy or chemotherapy for seven to eight weeks.
But the researchers found little evidence that postponing surgery for pancreatic and stomach cancers worsened the results, in part because few studies were available.
The results were recently published online in the Journal of gastrointestinal surgery.
Fligor said the results should be interpreted with caution.
“The studies we reviewed were not designed to answer the question” how long should you operate on cancer during a pandemic? “- because it is something that we did not experience in our lifetime,” he said.
Cancer is a progressive disease and delays in treatment can give it time to develop and spread. While some delays can be fatal, others can cause no significant cancer growth.
The outcome depends on the length of the delay, the type and stage of the cancer, as well as specific biological and genetic factors, suggest the study authors.
“There really is an individualized view of what is best per patient in a specific case,” said Fligor.
Dr. William Cance, medical and scientific director of the American Cancer Society (ACS), reviewed the results of the new study.
Cance said continuing treatment – be it surgery, chemotherapy or radiation – within 30 days of diagnosis is a reasonable recommendation for all cancers.
But it is not always true that the assumption that the faster you get rid of cancer, the better it will be for the patient is not true.
“We don’t want extraordinary delays, but on the other hand, we don’t want patients to be brought into surgery too quickly,” said Cance. “I have seen too much rushed care, and we run the risk of going too far the other way.”
During the early stages of the COVID-19 pandemic, hospitals postponed numerous elective surgeries, including many cancer surgeries, in order to free up resources for the planned flooding of coronavirus patients.
Further delays are likely as the pandemic continues and hospitalizations for COVID-19 increase.
If surgery needs to be delayed, Cance recommends that doctors consider alternatives such as chemotherapy or radiation to prevent the cancer from progressing in the meantime.
“I think the important point is that patients need to have their treatment plan developed,” said Cance.
But delayed treatment is not the only cause for concern: getting a rapid diagnosis during the pandemic is also a problem.
“We do a very good job of caring for patients with a diagnosis, but it is those without a diagnosis that worry me,” said Cance. “It is people without a diagnosis who are put in the background with screenings.”
A recent ACS survey found that most cancer patients were treated as planned in late April and early May. Only 17% of people on active cancer treatment reported delays.
“I think the data shows that we strive to prioritize patients with a diagnosis,” said Cance.
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