In March and April just 97 cases of prostate cancer were diagnosed throughout Hartford Healthcare compared with 233 cases in 2019. The stark decline holds true for digestive cancers with a 42 percent decline in diagnoses and breast cancer with a 30 percent decline in diagnoses compared to the same period in 2019.
“If you don’t diagnose, you can’t treat,” said Dr. Peter Yu, physician in chief at Hartford Healthcare’s Cancer Institute. “We are going to diagnose these cases, but they will be much harder to treat when we do.”
The concern is that a two to three month delay could result in later stage diagnoses and worse outcomes for cancer patients.
“Over the last decade we have seen a 30 percent decrease in deaths due to cancer,” Yu said. “A large part of those lives saved is because we found the cancer early enough. If we aren’t screening, we are going to lose that.”
Due measures put in place to slow the spread of COVID-19, nearly all routine cancer screenings were canceled and many visits for those experiencing symptoms were delayed across Connecticut and the country, Yu said. According to data pulled from all EPIC users – the largest medical health record – screenings for breast cancer dropped from 10,000 to 559, for colon cancer from 3,000 to 402 and for cervical cancer from 1,000 to 66 weekly.
“We said in the middle of the COVID environment, we have to have resources to test and treat COVID. We don’t want people coming into the hospital, so we voluntarily turned off the faucet in April,” Yu said. “But now, COVID cases in the hospital have fallen dramatically, and we feel urgently the need to get back to screening.”
And they have started to.
At Hartford Healthcare this week, radiology departments resumed routine mammography scans. At Yale-New Haven Health, mammograms along with colonoscopies started up in May.
“To compensate for the about six weeks we were totally stopped we are expanding access throughout the system,” said Dr. Kevin Billingsley, chief medical officer at Yale Cancer Center and Smilow Cancer Hospital. “We are expanding hours into the evening and scheduling procedures on weekends to manage the backlog of diagnostic procedures as well as surgeries.”
Even as screenings become available again, both Yu and Billingsley said the problem is convincing the public to come to the hospital.
“As the pandemic hit in full force, many people really stopped interacting with the healthcare system,” Billingsley said. “Mild symptoms which would have taken people into the healthcare system before, people have been living with.”
At both Yale-New Haven Health and Hartford Healthcare separation of staff and patients, mask wearing and stringent cleaning procedures have been put in place that in many ways make it less likely for a person to catch COVID-19 during an outpatient visit than at the grocery store. But, as Dr. Eva Chalas, the Physician Director at Perlmutter Cancer Center at NYU Winthrop Hospital said, people are scared.
“The big problem is that our government is regularly telling patients to stay home, which is reasonable if you don’t have any symptoms, but if you have symptoms people need to know it’s safe to go to the hospital,” Chalas said. “We need that message to get out.”
To help patients feel safer, Chalas said, at NYU Winthrop Hospital patients have the option of a “virtual suspicion of cancer” visit. The virtual appointment allows the patients symptoms to be assessed and the need for additional testing to be determined. In that way, Chalas said, patients who are likely not suffering from cancer, do not need to come in to the hospital.
The long-term consequences
Whether or not a six-week, two-month or three-month delay in diagnosis has an impact on the patient’s outcome is totally dependent on the type of cancer.
“Some cancers are very slow growing and some are very aggressive,” Chalas said. “Unless it is a very rapidly growing cancer this time frame of delay is likely not a problem, but much beyond that the risk just gets greater.”
Chalas said she plans to document the prognoses of patients diagnosed throughout the aftermath of the COVID-19 pandemic and then look back on it a year from now. The data, she said, over the course of the next year will bear out whether the delay was too long.
According to Dr. William Cance, chief medical and scientific officer with the American Cancer Society, the cancer that is most concerning to him at this time is colon cancer.
“Any delays have a potential to be problematic, but it is cancer type dependent. The colon worries me a lot,” Cance said. “Each colonoscopy takes so long and ENDO suites were sut down along with ORs for this entire time. You can’t just scale up the same way you do with mammograms.”
For every 1 in 91 colo-rectal cancer screenings there is typically a positive diagnosis, Cance said. In a three-month shut down across the United States that would be 1.7 million less screenings, that’s just under 20,000 undiagnosed cases.
“We can’t prioritize everybody, but if you have a first degree relative with a history of colon cancer or any GI-symptoms please see your doctor, advocate for yourself,” Cance said.
Cance said that right now it is important that patients be proactive because hospitals do not have a system in place to ensure that those with canceled appointments get in before those that were already scheduled for this summer.
And the focus shouldn’t just be on this summer and these patients, Cance said
“We need to set up a paradigm for the next pandemic so that patients just don’t go to the back of the line when their appointment gets canceled as is happening now,” Cance said. “We need to change the mechanisms to not let this happen again.”
Instead of simply working to catch up on the backlog of patients the COVID-19 pandemic produced, Cance suggested, hospital systems should be working toward preparing for the next pandemic. Preparing, so that this delay and its potential fallout doesn’t happen again.