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What is the cancer care system like during the coronavirus? According to a report prepared for the Ministry of Health, the area most affected by the COVID-19 pandemic in oncology is prevention. Patients were afraid of contact with medical institutions, and what is worse, some of the places where research are carried out were closed for a long time.
Oncology during a pandemic. The cytology suffered the most
The report “Impact of the Covid-19 pandemic on the cancer care system” for the NIO and the Ministry of Health was prepared by a group of experts.
The report reads that the key impact on reducing the number of screening tests in Poland was the announcement of the President of the National Health Fund issued on March 15, 2020 on limiting screening tests in order to avoid the risk of spreading COVID-19 infection.
– Pap smear, ie screening for cervical cancer, has suffered the most. As for mammography, it had a very large decrease, but at the end of 2020 it returned to a level comparable to that from before the pandemic – said Prof. Piotr Rutkowski, deputy director of the NIO.
In the period April – May 2020, 85 percent was performed. less pap smear tests, by 94% less mammography and 85 percent fewer colonoscopies than expected based on the 2019 tests. Taking into account the period March – September 2020, the reduction in the number of smear tests was 50%. compared to the previous year, mammography – 39 percent, colonoscopy – 28 percent.
In addition to prophylaxis, oncological rehabilitation suffered the most, because most of the rehabilitation centers did not work. In some voivodships, the decrease in the number of services provided in this area was 50%.
- Oncology in the time of COVID-19
– We also analyzed the number of cancer diagnoses. In 2020, we can talk about its decrease amounting to approx. 20%. It might seem that these are shocking data, but if we look at the results of other countries, it turns out that this is an average result – said Prof. Rutkowski. The reduction of new diagnoses of colorectal cancer in the period April – May 2020 was 26%, and in the scale of the entire last year – 13,5%. In the case of lung cancer, there was a decrease by 14%, and in the case of breast cancer, the number of new hospitalizations decreased by 11%.
Oncological treatment without delay
Prof. Rutkowski emphasized that the number of councils, although lower than in 2019, remained at the 2018 level, which means that if the patient was diagnosed with cancer, he would be treated. And this without major, significant delays.
– When it comes to procedures, surgical treatment, which we have talked about from the beginning, has seen a significant decrease. If there was no diagnosis at the right moment, the sick person could not be treated. In addition, some oncological surgery procedures are performed outside oncology centers, in multi-specialist hospitals, which were often transformed to fight the pandemic, the expert explained.
- Not only Kadcyla. Cancer drugs have quietly disappeared from the list
The least affected by limitations were chemotherapy and radiotherapy procedures. The exception was the second wave of the pandemic, in which they fell by 50%.
– In the case of drug programs – the number of patients who were treated under them increased during the pandemic. Patients were referred to oncology centers, so there was no dispersion of programs to other units. In addition, during the pandemic, the number of drug programs increased, for example for lung cancer and breast cancer programs – reminded prof. Rutkowski.
– We also analyzed the speed of treatment initiation, i.e. the timely implementation of procedures after the first contact. If the patient was already diagnosed with a cancer center, the treatment proceeded without any major problems. We also don’t see a huge excess death rate from cancer, as most of the deaths, however, are related to Covid-19. However, there are cancers where a greater number of deaths are particularly noticeable, including lung cancer – said the oncologist.
COVID-19 and cancer mortality
The authors of the report emphasize that the mortality rate of Covid-19 in cancer patients is higher than expected based on age, but only in some cancers, mainly lung, pancreatic, liver and hematological cancers. In the authors’ opinion, in the case of lung cancer it seems to be related to the very essence of the disease, concerning the respiratory system. The reason may also be the reduced monitoring of patients with chronic viral liver infection in infectious wards (hepatocellular carcinoma), or the need for rapid diagnosis and therapy (pancreatic cancer). In most cancers, such as breast cancer, colorectal cancer, prostate cancer or melanoma, the effect of COVID-19 on mortality is not seen.
- «We are dealing with a tsunami – a tsunami of advanced cancer»
The impact of the pandemic on Polish oncology can also be seen from the financial side of oncology hospitals, which, as Prof. Jan Walewski, director of the NIO, have significantly higher operating costs, which is related to, inter alia, with the necessity to provide a huge number of personal protective equipment, as well as intensive testing of patients and staff (although since the spring, when the lion’s share of employees of oncology centers were vaccinated against COVID-19, testing of personnel is much less frequent).
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