The devastating effect on cancer care of cancelling elective surgeries during the pandemic

The Canadian Cancer Survivor Network’s survey of cancer patients and caregivers across Canada has revealed the devastating effect of the cancellation of elective surgeries on cancer patients. The survey was conducted by Leger for the CCSN in late May and early June. In total, 1243 people were surveyed, among them cancer patients, pre-diagnosis patients, and caregivers of cancer patients. Most of the respondents were from Leger’s LEO panel, and some found the survey through the CCSN’s website.

The survey shows clearly that the delays in elective surgery have taken a tremendous psychological toll on patients and caregivers. Anxiety about worsening outcomes and uncertainty about how quickly they can get care – either procedures that they already need, or care required for new developments – are top among the concerns of those surveyed.

Of those who took part in the survey, 12 percent of patients and 23 percent of caregivers surveyed had a surgery or scheduled procedure for cancer cancelled or postponed. Among patients diagnosed fewer than two years ago, the number is greater – just over one in five. Additionally, 30 percent of pre-diagnosis patients had a scheduled procedure to confirm a cancer diagnosis postponed or cancelled.

‘Elective’ might sound like it means ‘optional’, but in fact an elective surgery is simply any surgery that is scheduled in advance. That is, elective surgeries are those that, although they are usually medically necessary, are not considered so urgent that they cannot be delayed. Most cancer-related surgeries are elective.

A common concern among survey respondents was that their cancer would get worse – or recur, if they are in remission – with tests, treatments, and procedures postponed. 36 percent of cancer patients, 68 percent of caregivers, and 68 percent of pre-diagnosis patients in the survey were significantly more worried during COVID-19 about their cancer progressing.

This concern was especially common among patients who were diagnosed recently, caregivers for recently diagnosed patients, and pre-diagnosis patients. Among patients diagnosed less than two years ago, the figure was 53 percent; for caregivers of patients diagnosed less than two years ago, it was 82 percent.

“I was supposed to have surgery to remove my ovaries because I have a cyst and I also do not know if I have ovarian cancer,” said an Ontario stage 4 breast cancer patient. “This delay in elective surgery worries me.” For pre-diagnosis patients whose previously planned surgery would confirm a diagnosis, they must live with that uncertainty – and the potential for the cancer to spread, if they indeed have it – for much longer.

The still-accumulating backlog of surgeries means delays for newly planned surgeries too, for as long as it takes until the hospitals catch up. This causes additional stress for cancer patients and caregivers, who are worried about what treatment and care they may need in the future at least as much as about current treatment.

“I was worried that if I had any symptoms of my cancer spreading again I would be unable to be admitted to hospital or undergo an operation,” wrote a Nova Scotia patient with osteosarcoma in the survey, who feared “that if I had needed an operation or treatment I would not be admitted into the hospital and that it would be delayed until it was too late.”

Among those surveyed, 46% of patients, 67% of caregivers, and 59% of pre-diagnosis patients were concerned about being able to receive cancer treatment, including surgery, if needed. Similar numbers were concerned about being able to receive hospital care – for cancer or for other reasons. Among patients, those diagnosed less than two years ago were again more likely to have these worries.

For some cancer patients, the short notice of the postponed surgeries, and the uncertainty as to when they will be rescheduled, sends the message that their cancer care is no longer considered important. “It’s as if all health care other than COVID-19 has been put on the back burner,” says a stage four prostate cancer patient in Alberta. “All other health care patients are being sacrificed for COVID patients. I’m scheduled to have surgery for removal of a kidney stone, but that procedure has been postponed indefinitely.”