What COVID-19 could mean for cancer diagnosis and prognosis

Australian doctors predict a 30 per cent decline in cancer diagnosis in Australia because of COVID-19. OTR reporter Alyssa Cairo finds out what the impacts of the decline really are. (Image source: MIMS Today)

By Alyssa Cairo | @AlyssaCairo_

The government’s response to the COVID-19 pandemic has tested the resilience of the public healthcare system. But experts overseas are warning Australians of the post-COVID-19 impact on cancer diagnosis and prognosis.

An article by Professor Maarten IJzerman and Professor Jon Emer from the University of Melbourne notes a global cause of concern is the falling rates of cancer diagnoses.

Director of scientific relations at the National Foundation for Cancer Research Dr Hali Hartmann says the fear of going out in public and contracting coronavirus has caused patients to postpone or cancel medical appointments.

Patients who are deferring medical advice for lumps and bumps, which are common symptoms of cancer, are being urged by Australian doctors to continue to seek medical advice.

Associate professor in radiation oncology at Icon Cancer Centre, Michael Penniment, says patients who are deferring medical advice for persistent symptoms “are likely to present later with more advanced and potentially incurable disease”.

“It is very important for people to speak to a doctor if they are concerned about their health, rather than putting this off due to COVID-19,” he said.

“In Australia, the numbers of active COVID-19 patients are low and falling and there are many effective screening processes and telehealth options in place at healthcare facilities to protect patients and staff from COVID-19.”

Australian doctors and researchers are posing the question: ‘Is delayed cancer diagnosis a consequence of COVID-19? after the Netherlands Cancer Registry reported a 40 per cent decline in cancer incidence per week.

Skin cancers, male genitourinary cancers and blood cancer incidences were also reported to be 30 to 40 per cent lower than normal.

An alarming 75 per cent reduction in referrals for suspected cancer since the start of COVID-19 restrictions in the United Kingdom has also rung alarm bells.

Although specific Australian cancer incidence data during the COVID-19 pandemic is yet to be released, there is related health service data suggesting Australia could experience similar declines.

Professor Penniment says Australian doctors expect to see a 30 per cent national drop in cancer incidence rates.

As a consequence of putting-off medical appointments, doctors are expecting to see a wave of cancer cases later in the year.

“Australia’s healthcare system may struggle with capacity, resulting in longer waiting times to access care, as well as a greater number of people being diagnosed with more advanced stages of cancer,” Professor Penniment said.

Amid the peak of the pandemic, services like BreastScreen SA made the ‘difficult decision’ to temporarily close screening clinics to protect staff and patients.

The service, which was re-opened after a couple of weeks, provides free screening mammograms to South Australian women over 50 years old and aims to detect breast cancer before lumps can even be felt.

Several cancer support groups and members of the public took to social media to say while the need to control the spread of coronavirus is vital, the decision to temporarily cease early-detection services could lead to fatal delays in detection.

But, the head of clinical oncology research and head of the unit of the combined haematology and medical oncology service at The Queen Elizabeth Hospital, Professor Timothy Price, said there is far less cause for concern for early detection centres impacting prognosis rates.

“For the patients that were going there for what it was designed to do, that two-week gap shouldn’t have had an impact because it would have been early disease that was being screened for,” Professor Price said.

Professor Price and Professor Penniment agreed that the main cause of concern is the patients who are displaying or experiencing persistent symptoms, but choosing to defer medical advice.

“I think now we’re going towards two months and that certainly—once you go beyond four, six weeks getting up to two months—there is certainly the risk that that delayed diagnosis may impact on the prognosis because the stage may be higher, so we are getting to that period now,” Professor Price said.

Professor Price says that despite Australia’s successful attempt to flatten the curve, patients are “still reporting that they’re not that keen to go out although the peaks finished.”

“I had an example of someone who probably physically if I had seen them I would have noticed changes, but on the phone they were telling me ‘they were fine’ and they ended up coming to emergency and obviously they weren’t fine.”

Professor Price says for patients who present to doctors in Australia, the diagnosis and treatment process is operating as normal and “we haven’t had a huge resource strain that a large COVID-19 outbreak would have.”

In countries like the United States and Japan, where the impact of the pandemic has been felt more, patients are experiencing testing delays and, in some cases, unacceptable discontinuation of existing treatment plans.

The National Foundation for Cancer Research’s Dr Hartman said: “Hospitals and their surgeons may not be or were not performing all surgeries due to COVID-19 pandemic intensity in the particular countries and cities.”

An example is the neuro-oncology treatment guidance during the pandemicdeveloped to balance risks between possible tumour progression, health-care resources and COVID-19 associated risks.

Developed by Dr Tao Jiang at Beijing Tiantan Hospital, in partnership with the US, the guidelines help neuro-oncologists and neuro-surgeons adopt a set of ‘new normal’ practices.

This includes monitoring or treating patients with deadly brain tumours during the pandemic, which include postponing surgery and further testing.

While Australian data on incidence rates is yet to be published, Professor Price says for people who are presenting with common symptoms it all comes down to education.

“We are in a good place and it is safe and important to have any concerns reviewed,” he said.

“Patients can even, if worried, at least ask for telehealth visits” to avoid later diagnosis of advanced stages of cancer.

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