ONCOLOGY IN THE SHADOW OF THE PANDEMIC
We are not afraid of any other disease as much as we are afraid of cancer. Despite this, the coronavirus pandemic has pushed the treatment of cancer patients into the background in the healthcare system. We talk about oncology in the shadow of the pandemic with Dr. Marcin Hetnal, medical director of the Amethyst Radiotherapy Center and head of the radiotherapy department at the hospital. L. Rydygier in Krakow.
I have the impression that in the era of coronavirus, we have forgotten about another - more dangerous from the point of view of patients' health and life - epidemic of the XNUMXst century, the cancer epidemic.
Definitely yes. In the medical community, we are all aware that the coronavirus pandemic has largely disrupted the entire health care system. This does not only apply to oncology, many other specialties experience the same. During the pandemic, all diseases fell into the background. It began to seem to us that the main problem was COVID-19. Of course, I am far from downplaying the coronavirus, but every day - also during the pandemic - several hundred people are diagnosed with cancer in Poland.
And Covid and cancer are a combination that can have dramatic consequences for the patient...
Unfortunately yes. Oncology patients are at greater risk of severe disease and death due to COVID-19. It is estimated that the mortality rate for older people, especially those over 70 years of age, with the coexistence of cancer and COVID-19, is as high as 27%. Much more than in the case of chronic obstructive pulmonary disease (COPD), ischemic heart disease or asthma.
The situation in oncology is serious, not to say catastrophic.
Research shows that comparisons of cancer treatment results before and after the pandemic are poor. Many countries use mathematical models that, based on available data, allow us to assess how much the treatment results will deteriorate. We do not yet have such studies for Poland, but we can confirm this by analogy to those published for Great Britain. Well, it is estimated that the five-year survival rate in the UK has decreased for colorectal, breast and esophageal cancer. For colorectal cancer, 15% and for breast cancer approximately 10% additional deaths are predicted for 5 years, comparing it to the period before the pandemic. British cure rates have so far been better than ours in Poland, so we can expect at least similar declines.
Many people took the slogan "stay at home" too literally.
This was especially visible in the first months of the pandemic. At that time, the number of radiotherapy and chemotherapy administrations dropped significantly compared to the same months in previous years. Both at the Amethyst Radiotherapy Center and at the hospital. L. Rydygier, we recorded a significant decrease in the number of patients in April and May last year, which was an obvious result of the suspension of the functioning of many medical facilities and the fear of patients about the coronavirus. Official data shows that significantly fewer DILO (Diagnostics and Oncological Treatment) cards have been issued, which enable patients to use the fast track cancer treatment. Unfortunately, the pandemic meant that patients with already diagnosed cancer had major problems with carrying out further tests or their planned surgeries were postponed. Another part of the patients was not diagnosed at all because primary care clinics had been working mainly by telephone consultations since March. This could limit the detection of disturbing symptoms and delay diagnosis. To this should be added the fear of many people before visiting a clinic or hospital. People were afraid of getting infected with the coronavirus, so they postponed all contacts with health care. Fortunately, this situation has changed. Patients understood that cancer would not wait until the end of the pandemic.
And that earlier treatment is one of the factors that gives a chance for recovery.
It must be clearly stated that delaying the start of treatment increases the risk of death by up to several percent. Therapy started later is also longer and more burdensome. In the case of rapidly growing tumors, including: located around the head and neck, lungs, cervix, every day counts. Therefore, despite the ongoing pandemic, we did everything to ensure that the effectiveness of the entire course of oncological therapy remained unwavering. As Amethyst Radiotherapy Center and hospital. L. Rydygier, I think we are passing this exam, at least so far. We had to take over some patients from hospitals whose wards were transformed into Covid wards. We did not leave oncology patients to themselves even for a moment. The worst was last fall. At that time, as medical staff, we were not vaccinated yet. There were situations when, in the morning before the start of duty, we learned about the positive test results of several nurses and patients. It was a time of great strain, both physically and mentally.
When I talk to doctors, I hear more and more often about victims of teleconsultations that were supposed to be only for a moment, but have been there for over a year.
Teleconsultation has many advantages and allows patients to contact a doctor even if it is difficult to reach the clinic. However, they have their limitations and cannot replace direct contact. In the case of the Amethyst Radiotherapy Center, we provide teleconsultations mainly for patients who have already completed treatment and remain under the care of a radiotherapist for further observation. If, during the teleconsultation, the patient signals that something is bothering him, I immediately make an appointment for him in the office. Introduction of mass teleconsultations in specialized fields of medicine, including: such as oncology is highly inadvisable. Unfortunately, I can multiply examples of patients who came to me too late because of closed clinics and hospitals. The case of a young mother in her forties is particularly memorable. It was a patient from a neighboring province. She had lung cancer. For three months she fought for attention. First, to register with a doctor, then to have someone examine her. She came to me with brain metastases. Of course, she could have had them before, but, as we have already said, a quick diagnosis definitely increases the patient's chances of recovery. This patient told me about the hardship she had to go through to fight for her health and life. We did everything we could to help her. However, in tumors metastatic to the brain, the prognosis of patients is not optimistic...
Unfortunately, there are more such patients left to their own devices. Is it true that after a year of waiting, more patients now see doctors in an advanced stage of the disease?
Unfortunately, there are many examples of patients diagnosed too late and those who did not see a doctor on time. That's why it was so important for us to maintain business continuity. Both at the Rydygiera Hospital and the Amethyst Radiotherapy Center, we recognized from the very beginning that oncology was a field that could not wait. I have seen various cases in my work. However, I have no doubt that now more patients in advanced stages of the disease come to us. In the initial months of the pandemic, the suspension of supplies of many pharmaceuticals used in chemotherapy was also a problem. Of course, we then implemented replacements. Unfortunately, these deficiencies in the case of some drugs have not yet been compensated.
One million Poles live with cancer. Every year, the disease is diagnosed in over 160 people. people, and 100 thousand sick people die. Despite this, oncology has been struggling with a lack of doctors and insufficient financing for years, and the pandemic has highlighted these shortcomings even more.
For many years, oncology was neglected. There are not many people willing to pursue this specialization. This is a fascinating, modern field of medicine, but different from all others. It requires teamwork in a large center and is very mentally demanding. Most oncologists do not have the opportunity to additionally see patients in private offices. Even though oncological specializations have been on the list of priority specializations specified by the Ministry of Health for several years, there is still a shortage of young oncologists. They prefer to start specialization that is easier and less burdensome. I conduct classes with students myself. When I ask them about their choices regarding specialization, only 2-3 people per year declare their choice of oncology very initially. It's very little. For this situation to change for the better, a wise recovery plan and much greater financing are needed.
The text was published in the Senior Forum supplement, which can be viewed in its entirety here Dziennik_Polski_dodat_specjalny_1_21_04_2021
