CANCER DISEASE DOES NOT WAIT FOR A CONVENIENT DATE

Regardless of the rapid increase in Covid-19 cases and the restrictions introduced, cancer patients must find quick and efficient medical help. In their case, any delay in treatment may reduce the chances of recovery, he emphasizes Maria Marczak-Ziętkiewicz, specialist in radiation oncology from the Amethyst Radiotherapy Center in Krakow.

What does the everyday life of the Radiotherapy Center look like during the epidemic?

Maria Marczak-Ziętkiewicz: If we talk about therapy, we treat the same way as before the emergence of Covid-19 cases. We use teleradiotherapy, brachytherapy and combined treatment in all patients whose treatment plan requires the use of such procedures.

However, the circumstances of treatment have undergone profound changes, and we have been working for many months, observing a strict sanitary regime. These rules also cover patients who undergo temperature measurement, complete questionnaires related to the coronavirus, and must adapt to the applicable rules, which may sometimes be burdensome for them.

This includes, among others: restrictions on entering our facility with accompanying persons and the obligation to come to the scheduled time of therapy or visit.

However, it must be remembered that all these restrictions are intended to ensure the safety of both patients and our team and to maintain the continuity of the center's operation.

Many clinics introduced teleconsultations at that time. Do you also use them for cancer patients?

MM-Z.: Teleconsultations are part of our contacts with patients. They cannot in any way replace the qualification visit for treatment and follow-up visits during radiotherapy. However, in other cases, patients willingly use the possibility of teleconsultation, which allows them to forgo the hassle of traveling and reduce the risk resulting from the epidemic.

However, in some situations it is estimated that teleconsultations could significantly delay the diagnosis of oncological patients.

MM-Z.: Yes, you can imagine such a situation, but in the group of patients treated at the Center we are at a different stage of treatment. Please remember that radiotherapy is an element of oncological treatment. We receive patients who are either undergoing treatment or have undergone diagnostics. We do not use tele-advice mechanically. First, the doctor prepares a list of patients who can be offered a visit via teleconsultation. Then, our employee of the Patient Service Point calls these selected patients and agrees with the patient whether teleconsultation will suit him. Sometimes, as a result of teleconsultation, the doctor sets a date for a normal, stationary visit.

Many oncologists warn that the epidemic regime has resulted in a significant decrease in diagnosed cancers and a reduction in the number of oncological patients, which is very disturbing.

MMZ: In our center, the decline in the number of patients was clearly visible in April, May and June. In March, we treated 180 patients a day, but in the following months the number increased to 140, 120, 110. Additionally, around August and September, we observed another disturbing phenomenon. Some patients came to us in an advanced stage of cancer. When we analyzed their medical history, it was clearly visible that they were stuck somewhere at the diagnostic stage, sometimes they were waiting on their own, afraid of contact with the health service during the epidemic. Their therapy began with a two- or three-month delay. Unfortunately, in the case of later-stage cancers, longer-lasting therapy is required, and the chances of cure decrease.

How many patients are currently being treated at the Amethyst Radiotherapy Center in Krakow?

MM-Z.: 170-180 a day, which is similar to before the outbreak of the epidemic. At the Radiotherapy Clinic, we are currently registering more visits than ever before. But we are concerned that further restrictions related to the epidemic will again scare patients who will stop visiting and stay at home. That's why I appeal to everyone - cancer treatment cannot wait for better times. Regardless of appeals to stay at home, any disturbing symptom should be consulted with a doctor.

Are you making any changes to therapeutic procedures due to the epidemic?

MMZ.: At the beginning of the epidemic, in accordance with the guidelines of the Polish Society of Radiation Oncology and the Polish Society of Oncology, we modified the treatment of some patients using simplified therapeutic regimens, provided that the same treatment effectiveness was maintained.

One of our biggest limitations is the availability of hospital beds. Patients undergoing procedures under general anesthesia, patients with complications and those undergoing combined treatment require hospitalization. In the latter case, we have increased cooperation with centers that use outpatient chemotherapy, which means that patients come from home for treatment.

The epidemic is stressful not only for patients, but also for all medical staff. How do you deal with this situation?

MMZ.: Sanitary regulations are an inevitable obstacle for everyone. We admit patients provided with additional personal protective equipment, it is more difficult to say hello, masks cover the smile and make communication difficult, especially with the elderly and people who are hard of hearing.

The fear resulting from the epidemiological situation often intensifies the patient's anxiety related to cancer and causes more tension and emotions in the relationship on both sides. This is an additional challenge for us.

Difficulties also apply to teamwork - we keep our distance, we work in shifts so that a possible quarantine covers as few people as possible, we also wear masks in the offices. But these are not the key issues. The most important thing is that we have been able to maintain the continuity of the operation of our facility and the treatment of patients for many months. This gives us satisfaction and strength to continue working.