Yvette Lowery usually gets her annual mammogram around March. But last year, just as the pandemic took hold and medical facilities ceased, the center she was going to canceled her appointment. No one could tell her when to reschedule.
“They just said keep calling back, keep calling back,” she said. Lowery, 59, who lives in Rock Hill, SC, said
In August, me. Lowery felt a lump under her arm, but could only make an appointment in October.
Eventually, she was diagnosed with stage 2 breast cancer, started chemotherapy in November, and had a double mastectomy this month.
“I have seen many patients at an advanced stage,” said Dr. Kashyap B. Patel, one of me. Lowery’s doctors and the CEO of Carolina Blood and Cancer Care Associates, said. If her cancer had been detected last May or June, it would probably have been caught before it spread, Dr Patel said.
According to experts, months of closures and waves of rising Covid cases closed clinics and laboratories during the past year, or reduced hours elsewhere, leading to a sharp decline in the number of screenings, including breast cancer and colorectal cancer.
Several studies have shown that the number of patients screened or diagnosed with cancer decreased during the first months of the pandemic. By mid-June, screening for breast cancer, colon and cervical cancer was still 29 to 36 percent lower than their prepandemic levels, according to an analysis of the data by the Epic Health Research Network. According to the network data, hundreds of thousands of fewer performances were done last year than in 2019.
“We still haven’t caught up,” says Dr. Chris Mast, vice president of clinical informatics for Epic, which develops electronic health records for hospitals and clinics.
Another analysis of Medicare data suggests that while Covid’s cases rose during certain periods in 2020, cancer investigations fell short. The analysis – conducted by Avalere Health, a consulting firm, for Community Oncology Alliance, which represents independent cancer specialists – found that test levels in November were about 25 percent lower than in 2019. The number of biopsies used to diagnose cancer, it decreased by about a third.
Although it is too early to determine the full impact of the delays in investigations, many cancer specialists say they are concerned about patients entering with worse illnesses.
“In practice, there is no doubt that we see patients with more advanced breast cancer and colorectal cancer,” says Dr. Lucio N. Gordan, president of the Florida Cancer Specialists & Research Institute, one of the largest independent oncology groups in the country. He is working on a study to see if these missed performances generally resulted in more patients with cancer at a later stage.
And although the number of mammograms and colonoscopies has recovered in recent months, many people remain undiagnosed with cancer, doctors report.
Some patients, such as Mrs. Lowery, could not easily get an appointment after clinics reopened due to pent-up demand. Others skipped regular tests or ignored worrying symptoms because they were afraid of becoming infected or after losing their jobs, they could not afford the cost of a test.
“The fear of Covid was more palpable than the fear of missing a screen that detects cancer,” said Dr. Patrick I. Borgen, chairman of the operation at Maimonides Medical Center in Brooklyn, which also leads the breast center, said. His hospital used to treat such large numbers of coronavirus patients that ‘we are now associated as the Covid hospital’, he said, and healthy people stayed away to prevent infection.
Even high-risk patients because of their genetic makeup or because they have had cancer in the past have missed critical investigations. Dr. Ritu Salani, director of gynecological oncology at the UCLA Health Jonsson Comprehensive Cancer Center, said one woman, who was at risk for colon cancer, underwent a negative test in 2019, but did not do her regular check-up last year. . pandemic.
When she went to her doctor, she had advanced cancer. “It’s just a devastating story,” Dr Salani said. “Screening tests are really designed when patients are not feeling bad.”
Ryan Bellamy had no rush last spring to reschedule a canceled colonoscopy, although the presence of blood in his stool prompted him to look up the symptoms. “I really did not want to go to the hospital,” he said. Bellamy said. He decided it was unlikely he had cancer. “They do not follow me, so I’m fine with Google,” he told himself.
A resident of Palm Coast, Florida, Mr. Bellamy, said his wife, after his symptoms worsened, insisted on going for a test in December, and he did a colonoscopy in late January. With a new diagnosis of stage 3 rectal cancer, Mr. Bellamy (38) radiation treatment and chemotherapy.
According to the Epic network data, colon screening remained significantly lower in 2020 and fell by 15 percent from 2019 levels, although total screenings fell by 6 percent. The analysis looked at performances for more than 600 hospitals in 41 states.
Lung cancer patients also delayed getting appropriate care, says Dr. Michael J. Liptay, chair of cardiovascular and thoracic surgery at Rush University Medical Center in Chicago. One patient had imaging that showed a spot on his lung, and he was supposed to follow it up, just as the pandemic hit. “Additional work-up and care has been postponed,” said dr. Liptay said. By the time the patient was fully evaluated, the cancer had increased in size. “It was not a good thing to wait ten months,” said Dr. Liptay said, though he was not sure if earlier treatment would have changed the patient’s prognosis.
Just as previous economic recessions led people to forgo medical care, the downturn in the economy during the pandemic also discouraged many people from seeking help or treatment.
“We know that cancer is there,” said Dr. Barbara L. McAneny, CEO of New Mexico Oncology Hematology Consultants, said. Many of her patients stay away, even if they have insurance, because they cannot afford the deductions or co-payments. “We see that especially with our poorer people who live on the edge anyway, salary to salary will live on,” she said.
Some patients ignored their symptoms for as long as possible. Last March, Sandy Prieto, a school librarian in Fowler, California, had a stomach ache. But she refused to go to the doctor because she did not want to get Covid. After having a telegealth visit to her doctor in primary care, she tried medication without a prescription, but it did not help with the pain and nausea. She kept deteriorating.
“It was at that point that we had no choice,” said her husband, Eric, who repeatedly urged her to see a doctor. Jaundice and in severe discomfort, she went to the emergency room in late May and was diagnosed with stage 4 pancreatic cancer. She passed away in September.
“If it were not for Covid, we could have found her a place sooner, she would still be with us today,” says her sister, Carolann Meme, who tried to help me. Persuading Prieto to go to an academic medical center where she might have come in for a clinical study.
When patients like Mrs. Prieto is not seen in person but is practically treated, doctors can easily miss important symptoms or recommend medication rather than telling them to come in, said dr. Ravi D. Rao, the oncologist who hired Mrs. Prieto treated, said. Patients may appreciate less how sick they feel or not mention the pain in their hip, he said.
“In my mind, telemedicine and cancer do not travel together,” said Dr. Rao said. While also using telemedicine during the height of the pandemic, he says he worked to keep his offices open.
Other physicians defended the use of virtual visits as a critical tool when office visits were too dangerous for most patients and staff. “We were grateful that we made a strong telemedicine effort if people simply could not get to the center,” said Dr. Sponsors of Maimonides said. But he acknowledged that patients were often reluctant to discuss their symptoms during a telehealth session, especially a mother whose young children could listen to what they said. “It’s not private,” he remarks.
Some health networks say they have taken aggressive steps to counter the effects of the pandemic. During the initial home order last year, Kaiser Permanente, the large care company in California, noticed a decline in breast cancer examinations and diagnoses in the northern part of the state. “Doctors got together immediately” to start contacting patients, Dr. Tatiana Kolevska, medical director of the Kaiser Permanent National Cancer Program, said.
Kaiser also relies on its electronic health records to make appointments for women who are in arrears for their mammograms when they book an appointment with their doctor in primary care or even want to get a prescription for new glasses.
While Dr. Kolevska says she is waiting to see data for the system as a whole, she has been encouraged by the number of patients in her practice who are now aware of their mammograms.
“All of these things that were put in place helped tremendously,” she said.