Tough Decisions as COVID-19 Causes Cancer Surgery Delays
Many cancer patients have faced delays to their health care during the coronavirus pandemic, but with what consequences?
Researchers at Beth Israel Deaconess Medical Center in Boston analyzed 15 years of data to determine how long surgery for certain types of cancer can be delayed without harming patients' chances of survival. The study began in early spring, as the pandemic led many hospitals to cancel or postpone non-emergency procedures, including surgery for cancer.
"We were worried that the surgeons and patients were being forced to make treatment decisions without a clear understanding of the risks," said Dr. Scott Fligor, a general surgery resident who led the review.
From more than 2,000 papers published in the last 15 years, his team found 58 that investigated the time between diagnosis and surgery in patients with cancers of the colon, pancreas and stomach.
These studies underscored the importance of prompt treatment for colon cancer. Specifically, a 30- to 40-day delay in surgery was associated with worse survival odds. The same was true after delaying rectal cancer surgery for seven to eight weeks after radiation or chemotherapy.
But the researchers found little evidence that postponing surgery for cancers of the pancreas and stomach worsened outcomes, in part because few studies were available.
The results were published online recently in the Journal of Gastrointestinal Surgery.
Fligor said the findings should be interpreted with caution.
"The studies we reviewed were not designed to answer the question 'How soon should you operate on cancer during a pandemic?' -- because this is something that we have not experienced in our lifetime," he explained.
Cancer is a progressive disease, and treatment delays can give it time to grow and spread. While some delays may prove deadly, others may cause no significant growth in cancer.
The outcome hinges on the length of delay, the type and stage of cancer, as well as particular biological and genetic factors, the study authors suggested.
"There really is an individualized vision for what's best per patient in a specific case-by-case basis," Fligor said.
Dr. William Cance, chief medical and scientific officer for the American Cancer Society (ACS), reviewed the new study findings.
Cance said moving forward with treatment -- be it surgery, chemotherapy or radiation -- within 30 days of a diagnosis is a reasonable recommendation for all cancers.
But the assumption that the faster you take out a cancer, the better it will be for the patient is not always true, he added.
"We don't want to have extraordinary delays, but on the flip side, we don't want to have patients taken too quickly to surgery," Cance said. "I've seen too much rushed care, and we run the risk of going too far in the other direction."
During the early stages of the COVID-19 pandemic, hospitals postponed many elective surgeries, including many cancer surgeries, in order to free up resources for the anticipated flood of coronavirus patients.
More delays are likely as the pandemic continues and hospitalizations for COVID-19 rise.
If surgery must be delayed, Cance recommends doctors consider alternatives such as chemotherapy or radiation to keep cancer from progressing in the meantime.
"I think the important point is that the patients should get their treatment plan made," Cance said.
But delayed treatment is not the only cause for concern: Getting a prompt diagnosis during the pandemic is also an issue.
"We're doing a pretty good job of getting patients with a diagnosis treated, but it's those without a diagnosis that I worry about," Cance said. "It's the people without a diagnosis that are getting put to the back of the line with screenings."
A recent ACS poll found that most cancer patients were treated as scheduled during late April and early May. Only 17% of those in active cancer treatment reported delays.
"I think the data shows that we are making every effort to prioritize the patients with a diagnosis," Cance said.
There's more about coronavirus and cancer at the American Cancer Society.
SOURCES: Scott Fligor, MD, general surgery resident, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston; William Cance, MD, chief medical and scientific officer, American Cancer Society; Journal of Gastrointestinal Surgery, June 30, 2020, online