Delays Of Surgeries Seem To Be Non-Life-Threatening For Women With Early-Stage Disease
Guest post from Dr. Shyamali Singhal, MD
Founder of Hope & Beauty
Through the early weeks and months of COVID-19, when hospitals were arranging to deal with a rush of patients, all elective surgeries — which included early-stage breast cancer surgeries — were temporarily delayed or permanently canceled. Has this caused issues for cancer patients? In this blog, we take a closer look at this problem.
Lowering the average number of performed surgeries during this year generally meant that a surgery that was instantly needed to save a life would indeed be performed, but any surgery whose delay would not directly damage patients’ health was postponed.
This delay in surgery or some other form of treatment has been causing a disturbance in many patients’ lives. Much of said disturbance is psychological in nature.
Surgery was generally performed only for patients with triple-negative breast cancers or those in immediate high-risk situations. Those with early-stage ER-positive breast cancers were instead treated with anti-estrogen or hormonal therapies. Surgery was postponed without a new set date. The early weeks of the COVID-19 pandemic have brought about a situation that even as much as 44% of breast cancer survivors had to delay some treatment or care.
COVID-19 And It’s Relation To Breast Cancer Prevention
Coronaviruses are a big group of viruses that can induce respiratory disease in people and animals. The coronavirus we’ve all learned so much about is called SARS-CoV-2, and the disease it causes is named coronavirus disease 2019. This is abbreviated, shortened, as COVID-19.
The virus that causes COVID-19 is highly contagious. It is estimated that it’s about 3 times more contagious than the flu virus. It spreads mainly through droplets of saliva thrown out when a person coughs or sneezes. People who are within 6 feet of an infected person may then inhale or otherwise get those infected droplets of virus-filled saliva into their noses, mouths, or eyes.
At this moment, there is still no vaccine or completely effective treatment for COVID-19. Some vaccines are in early testing stages, so there’s reasonable hope we will have it soon.
Because COVID-19 is so quick to spread when given a chance and to save healthcare means for people diagnosed with COVID-19, many hospitals delayed or canceled elective procedures. This included anything that didn’t need to be promptly done to save someone’s life. Breast cancer screenings were also considered as elective procedures, so many mammograms were delayed or canceled. Some breast cancer surgeries and other treatments also were delayed or canceled.
Surgical Delay Can Often Be Distressing
COVID-19 did not crackdown on the United States evenly. Some states recorded thousands of cases, while others had only a few hundred. Because of this, the delays in breast cancer care were very much different in different places. Surgery has sometimes been delayed in order to immediately start a patient on chemotherapy who is considered to be a especially high risk of forming metastatic breast cancer or with the hope of reducing the size of the primary tumor to avoid a mastectomy. Even in those situations, the surgical delay was often distressing. When first diagnosed with breast cancer, most people, naturally, just want the tumor out. It is very scary to live with the knowledge that a cluster of cancer cells is already in one’s breast, even if chemotherapy has started.
“Full effects of this pandemic will probably be felt deeply in many areas of medicine, but possibly none more so than in oncology,” said Dr. Shyamali Singhal, surgical oncologist and founder of H&B. It is imperative that patients continue to maintain their regular meetings and screenings to recognize and treat breast cancer in due time. The COVID-19 global pandemic should be used as an incentive for the health care system to seek out new possible ways to reach patients and assure that early detection screenings continue.
Human Connection Is A Crucial Part Of Healing
Delaying surgery in ER-positive early-stage breast cancer and, instead, starting with the treatment with endocrine therapy did not lower the odds of 5-year survival or increase the odds of a later stage cancer being finally diagnosed at the time of surgery. Before the pandemic, the average wait until surgery was less than 120 days for 98% of women. This delay is actually similar to what has transpired during the pandemic as hospitals have continued these surgeries after the first weeks of the epidemic.
This information has to be very pleasing to hear for those having a new cancer diagnosis matching with the pandemic. Dealing with either crisis is tough enough on its own; battling with both at once is terrifying. Waiting for surgery has been especially hard, but other aspects of new cancer care throughout the pandemic have been hard, also.
Some patients have said that it’s very disconcerting to have never seen their doctor in person without a mask. Others have mentioned the discomfort of not meeting their doctors in person at all but talking with them only online.
Since the human connection and human touch are a huge part of healing, placing these limitations has been bothersome. We want to remind ourselves that this too will pass.