Two years into this pandemic, we can see the impact Covid-19 is having on cancer services. As Ireland grapples with a fourth wave of Sars-CoV-2 infections, we must implement the lessons learned
For cancer patients around the world, the fear of Covid almost outweighed their fear of cancer – weakened immune systems placed many at a greater risk of infection, and of developing more severe symptoms compared with the general population.
Our healthcare systems were not designed to deal with a pandemic, so when Covid-19 emerged it caused a large-scale disruption to lifesaving services, cancer services in particular. Policymakers had a decision to make: shut down certain services to deal with the influx of Covid-19 cases, or reroute certain services. Thankfully, Ireland chose the latter.
While some public hospitals maintained their cancer services, the Government also made arrangements with private hospitals to ensure the continuation of care for cancer patients. Despite some inevitable delays, services were offered in “Covid-free” environments, which reduced the risk of exposure to Covid-19. This, as well as lockdown measures, such as stay-at-home orders, offered a degree of protection to people deemed to be at high risk.
Reductions in surgery
Although little data is available to effectively analyse the impact this had on health outcomes, it seems that cancer patients in Ireland fared better than those elsewhere. Studies from the UK, Canada, Norway, India and China indicate that there was a mass reduction in cancer surgeries. In particular, neurological, skin, colorectal and head and neck cancers were reduced up to 60 per cent during the first wave of the pandemic in these countries.
Furthermore, telehealth services for cancer patients also became more commonplace during the pandemic. Although you cannot diagnose or treat cancer over the phone, technology enables healthcare professionals to provide vital support services, such as counselling. As well as impacting physical health, cancer impacts a patient’s wellbeing and mental health at every stage of the disease, and the Covid-19 pandemic exacerbated this, as social isolation led to anxiety, fear and loneliness for many. In addition to being good for patients, telehealth also provided a platform for healthcare professionals who themselves were high-risk to continue supporting their patients.
Looking ahead, and preparing for the next wave of Covid-19 or indeed the next pandemic, continuing and improving these services is of paramount importance. Here in Ireland, we need a secure interconnected IT system. Not only will this produce data that equips policymakers to make smart decisions, it will allow experts to assess decisions made and provide analysis to improve future plans and share best practices between countries.
Continuation of care
Data should also assist in the transfer of services. In today’s world, we should be able to access a continuation of care at all points of entry – be it a GP’s office, a public hospital or a private hospital. This. however, requires a unique patient identifier, a serial number on each of our files so that our medical history is accessible to the clinician who is treating you at that moment. This would ensure a safer continuation of treatment for cancer patients – but would also provide for a better experience for the general population.
Protecting cancer services through dedicated centres and transitioning care out of public hospitals treating Covid-19 patients was a stroke of brilliance in the early days of the pandemic. However, as other healthcare services resume, it increases the foot traffic within centres of care, thus increasing the potential exposure to Covid-19 and in turn the fear of infection which may deter some from accessing services. We are at a critical juncture now and we cannot regress – we need to protect the ‘hubs’ that safeguarded cancer patients against Covid-19.
In addition to these efforts, the Government will also need to address the consequences of delayed and modified cancer treatments and screening. Comparing data from 2019 with 2020 we are seeing a global reduction of up to 92 per cent in cancer screening. We know that later diagnosis and delayed treatment adversely impacts health outcomes, quality of life and mortality for cancer patients. Addressing the backlog of cases and preparing pandemic-proof screening services is essential.
With no end in sight to this pandemic, we need to plan accordingly to ensure the safe continuation of lifesaving cancer services.
Dr Aileen Murphy is a senior lecturer in the department of economics at University College Cork. She is the project lead on the SEA-Covid-19 study examining the social and economic impact of Covid-19 on cancer patients, funded by MSD Global Oncology Policy Grant Programme conducted in collaboration with Breakthrough Cancer Research