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analysis: quebec is facing a 'disaster' in cancer care, experts warn
with a backlog of up to 24,000 oncology surgeries, "cancer patients feel abandoned by the system during this pandemic," one expert says.
jun 5 2020
7 minute read
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three months into the covid-19 pandemic , quebec is facing an unprecedented crisis in cancer care, with thousands of people walking around with malignancies that have gone undiagnosed and a potential backlog of about 24,000 oncology surgeries can no longer be delayed, experts in the field warn.
the crisis is all the more pressing because coronavirus outbreaks are still occurring sporadically in montreal hospitals where most of the cancer surgeries take place, putting patients at added risk of infection. yet the government is not devoting the necessary funds and hasn’t come up with a comprehensive plan, the experts have told the montreal gazette.
“people feel abandoned, yes,” said diego mena, director of advocacy for the quebec division of the canadian cancer society, describing the heightened anxiety among patients. “cancer patients feel abandoned by the system during this pandemic.”
the latest figures released by the quebec health ministry paint a disturbing portrait of the situation, with 30 per cent of chemotherapy and radiotherapy sessions still not available. what’s more, the overall backlog in elective surgeries has grown from 68,000 — a figure health minister danielle mccann cited last month — to more than 72,000 as of this week.
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of that number, 30 per cent are for oncology, estimated dr. gerald batist , medical director of the segal cancer centre at the jewish general hospital.
“this is frightening to many of us,” batist said. “this can be another disaster.”
in anticipation of the pandemic, the government shut down breast screening and endoscopies (which can detect colorectal cancer) for at least two months, while ramping down the number of semi-urgent oncology surgeries. authorities feared quebec’s hospital system would be overwhelmed — a worst-case scenario that unfolded in northern italy in february.
however, the pandemic rampaged instead through the province’s network of long-term care centres (chslds) and seniors’ residences, killing nearly 4,000 people. and as confinement measures and social distancing have succeeded in diminishing the number of covid-19 cases and hospitalizations, premier françois legault has focused on reopening quebec and giving priority to boosting the sagging economy.
“in all those early press conferences they said cancer patients were getting priority,” batist recalled. “and then that language disappeared and the chslds became the priority.”
“but this has to come back to where cancer is a priority,” he added. “they should be able to come up with a cancer plan because people have been thinking and talking about it since the beginning of the pandemic but they haven’t done it.”
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legault has acknowledged that the government’s blind spot in its initial pandemic response was neglecting to protect the chslds. but batist and others are worried the province may already have a new blind spot: failing to tackle quickly the enormity of the looming cancer crisis.
the pandemic struck quebec harder than other provinces. yet quebec lacks a full-fledged cancer agency like british columbia to coordinate oncology services.
the decision to postpone cancer diagnoses and surgeries means quebec faces a monumental challenge in ramping back up those activities in the context of the highly contagious coronavirus and with many hospital nurses already exhausted from having to care for patients in chslds while on temporary reassignment.
the pandemic’s impact on cancer care has been threefold: medical staff must ensure that cancer patients treated in hospital will not become infected with covid-19 (with research showing they are at a much higher risk of dying from the respiratory illness); a two-month delay in semi-urgent operations; and missed cancer diagnoses because breast screening and endoscopy were shuttered temporarily.
before the pandemic, one in 10 cancer patients taking part in a panel for the quebec chapter of the canadian cancer society expressed anxiety about access to care. by the end of april, four out of 10 patients said they were very stressed.
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“people who are calling our help line are worried about treatment and surgery,” mena said. “wait times for cancer surgery were an issue before. but with the pandemic, it’s much more than an issue, because a lot of people were in the semi-urgent category. they were in this grey zone. but now two months have gone by.”
batist also expressed concern about the backlog in surgeries. “what are we going to do with this mountain of surgeries that were delayed? we need a supplementary budget (in the tens of millions of dollars provincially) to catch up. we’re hoping that the summer schedule won’t be the regular summer schedule, that the government will fund the hospitals extra so that we can crank up the surgery during the summer, anticipating another wave.”
apart from announcing last month that surgeries would be increased, the health minister has not made public a cancer plan. at his daily briefings in the past two weeks, the premier and his ministers have unveiled plans to help the cultural and construction industries as well as to hire 10,000 orderlies for the chslds .
marie-claude lacasse, spokesperson for the health ministry, disclosed that 72,229 fewer surgeries of all types were carried out so far during the pandemic compared with the corresponding period last year. she was unable to provide a breakdown for oncology.
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in addition, 582 fewer patients started radiotherapy by the end of april compared with the same period last year.
lacasse noted that a ministerial sub-committee was formed at the start of the pandemic to deal with cancer care, and she cited a 12-page document for radio-oncology that was issued on april 24. the document does not contain any recommendations for ramping up cancer surgery.
batist, who took part in the daily meetings of the ministerial sub-committee, said he proposed that off-island hospitals that have not had covid-19 cases be used to clear the oncology backlog. this would entail granting temporary privileges to montreal surgeons to work in the off-island ors, which would run seven days a week.
“we’ve been told that’s too complicated and there are budgetary matters and problems with getting privileges,” batist said.
the health ministry does not dispute that the pandemic has resulted in missed diagnoses, but the government doesn’t know how many quebecers may be walking around with cancer without realizing it.
“the reduction in activities to carry out the diagnosis of cancers — consultation with a family doctor, screening, endoscopy, imaging, and surgery — and the reluctance still present in the population to consult with (a health professional during the pandemic) has had an impact on the number of cancer cases diagnosed compared with what would normally have been diagnosed,” lacasse explained by email.
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“work is currently underway to determine the number and nature of undiagnosed cancer cases and the medium and long-term impact. but it is still too early to produce an exact portrait.”
each month in quebec, 5,000 cancers are diagnosed, with lung, colorectal, breast and prostate cancers being the most common in that order. batist confirmed that breast screening and endoscopy were shut down for about two months.
that means that as many as 2,300 breast and colorectal cancers might not have been detected during this period.
barry d. stein, president of colorectal cancer canada and a cancer survivor, predicted the missed diagnoses will result in both a higher mortality rate and more cases of advanced cancer.
“we’re going to see a bump in the mortality rate,” he said, citing recent research out of calgary on this topic. “people are going to die because of that. there’s going to be more advanced cancers that are found. it’s pretty obvious that’s going to happen.”
the advanced cancers will not only mean greater suffering among patients, but lengthier and costlier hospital stays in the medium- and long-term.
and as far as what were once considered semi-urgent cases, batist conceded he’s not sure what a two-month delay in surgery will mean for those patients.
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“non-urgent cases in the case of cancer become urgent if left long enough,” he said. “just now, i’m looking at my patient list for next week and i’m seeing patients that two months ago i thought could wait. but now i have to see them and i have to assure myself that the wait was the right decision.”
mena, of the canadian cancer society, lamented that all this could have been foreseen. he alluded to a study into the sars hospital outbreaks in 2003 in toronto that found that missed cancer diagnoses became a big problem in the aftermath of the epidemic.
both mena and batist are urging the health ministry to act now by executing a high-volume cancer plan this summer. in the absence of a vaccine for covid-19, the coronavirus will linger in hospitals in the months to come.
a second wave might strike the health network in the fall, right before the start of the seasonal flu.
“in view of a second wave coming, we have a window to catch up,” batist said. “we can’t afford not to act now. the solutions are here already, and we can head off the next crisis.”
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