Thread by @ShikhaJainMD

Let’s talk about one cost of this pandemic we aren’t fully able to quantify. As an oncologist, care for my patients, and my potential patients is suffering because of #covid19. Even those who will never contract the disease themselves. Let’s unpack this.

cancer.org/about-us/what-…

Unfortunately, a less visible direct impact of the pandemic on patients with cancer & other chronic illness is the damage to their care we can’t quantify. Delays in
🏥diagnosis bc of necessary lockdowns
🏥surgeries bc of resources
🏥treatment ➡️ progression of disease.

As @FutureDocs described so well in this thread 🧵 👇🏽, care for both #covid19 and non-COVID19 patients is being sacrificed due to a lack of supplies, staff and space. As cases surge, other emergency and non-emergency care is delayed, or unable to be given.

https://twitter.com/futuredocs/status/1332397204238184450

Delays in surgery due to the need for prioritizing care will impact cancer care for patients for years to come. Even a 60 day delay in breast cancer surgery could lead to 7% more deaths in 10 years, almost 3000 more deaths of people with breast cancer.

ajmc.com/view/covid-19-…

A woman scheduled for breast cancer surgery to cure her may be delayed if there are no ventilators that can be used to support her during surgery. Her cancer surgery is delayed several months and her cancer grew and she now needs a more extensive surgery or can no longer be cured

Surges in patients with #covid19 also result in resources being reallocated away from other non-emergency interventions. A patient requiring neurosurgery was struggling to find an ICU bed and almost died before being flown to another state.

ky3.com/2020/11/17/hou…

At the start of this pandemic, we also saw a sharp decline in cancer screenings and treatments. This will likely result in an increase in morbidity and mortality for years to come.
ajmc.com/view/cancer-ca…

Screening tests such as colonoscopies and mammograms have significantly improved our ability to diagnose cancers and precancerous lesions early, resulting in more diagnoses at an earlier stage. With the drop in screenings, it is likely more later stage cancers will be discovered.

The 60 year old patient with no symptoms decides to delay his screening colonoscopy until after the pandemic (or his elective procedure is delayed). Now a year overdue, his precancerous polyp has become an invasive cancer that will require surgery and chemotherapy.

We are also seeing individuals not coming to the dr for symptoms they normally would have come in for (eg rectal bleeding) delaying care, waiting for #covid19 numbers to decrease. Unfortunately that delay may mean the difference between a stage 2 and stage 4 cancer.

Imagine a 43 year old young man with a month of rectal bleeding. He waits 5 more months for the pandemic to be under control, hoping it will he safer to get checked out. When the #covid19 surges keep coming, he finally gets his colonoscopy and his cancer is no longer curable.

A modeling study from the UK published in @TheLancetOncol estimates an increase of
➡️ 15.3-16.6% in colorectal cancer deaths (~1500 ppl)
➡️4.8-5.3% increase in lung ca deaths (~1250 ppl)

google.com/amp/s/www.phys…

A 55yo non-smoker w a cough is convinced it’s nothing and wants to wait until she is sure it’s safe. Her lung cancer that was initially a stage 1 now 9 months later is stage 4 and she will be spending her last days in the hospital, alone, because #covid19 rages on.

A study published in @JAMAOnc found a 46% weekly drop in diagnosis of 6 common cancers when compared to pre-pandemic. While #covid19 rages on, cancers do not stop. A lack of interventions to make the diagnosis does not mean the cancers are not there.

jamanetwork.com/journals/jaman…

An editorial in @TheLancetOncol describes an estimated

➡️ 3600 avoidable deaths in the UK w over 63K total years of life lost in the next 5yrs

thelancet.com/journals/lanon…

When we implore you to #wearamask #stayhome and #FlattenTheCurve, we are not asking this only to protect those who may contract #covid19. We are also trying to help those with other medical problems.

google.com/amp/s/www.wsj.…

When the hospitals run out of staff, supplies and space, cancer surgeries and screenings are sacrificed. Staff (nurses, drs, pharmacists etc) are redeployed, or worse, get ill themselves. Leaving patients with no one to care for them.

https://twitter.com/FutureDocs/status/1333243068946984960

As cases surpassed 13 million in the US, we worry for our cancer patients. Whether it’s delay in:
➡️ screening for prevention
➡️diagnosis initially or a recurrence
➡️ surgery due to a lack of resources OR due to lockdowns OR limiting elective surgeries
➡️Contracting #covid19

And of critically ill cancer patients who contract #covid19 have been found to be at high risk for severe disease and mortality. @GoHealio

healio.com/news/pulmonolo…

Patients who are receiving chemo and contract #covid19 often suffer from weeks or months in delay of therapy. Patients with cancer that was curable at the start of the pandemic, but treatment is put on hold bc they contract the illness, may end up no longer curable at the end.

And don’t forget, #covid19 required visitor restrictions. Our patients are
🏥 sitting and learning of their diagnosis alone
🏥admitted to the hospital alone
🏥Saying goodbye at the door to the ER, maybe for the last time.
🏥FaceTiming family to say their final goodbyes alone

The argument that #covid19 isn’t “that deadly” becomes moot when u realize we are not only talking about the people who contract it. This disease is deadly bc of its impact on hundreds of thousands of patients with cancer and other conditions who can’t receive the care they need.

It doesn’t matter if you have access to incredible cancer care if you can’t access the hospital bc there aren’t beds, you can’t have your surgery bc there aren’t supplies, you can’t be admitted to the hospital if you get sick, and you can’t be treated bc the staff is out sick.

So please, #WearAMask #StayHome stay #6FtApartAndMasked. Even if you think the pandemic isn’t real, believe me when I tell you my patients and their families are relying on you to do your part to help save their lives. @IMPACT4HC

Cc: @FutureDocs @marklewismd @DrMarkham @n8pennell @ASCO @alikhan28 @evebmd @fumikochino @NarjustDumaMD @DrSGraff @JulieSilverMD @HemOncWomenDocs @SuzanneColeMD @TomVargheseJr @pashtoonkasi @MaryPasquinelli @DrLFeldman1 @DamianoRondell1 @HemOncToday @WomeninOnc

Cc: @kschorsch @chrissyfarr @RyanNguyenDO @MeshaalKhanMD @YaelSimonsMD @DrVKGadi @Jbauml @rachnatshroff @SylviaFOX32 @Irumkhan_hem @SuzanneKovenMD