Cancer surgery delays brought on by the COVID-19 pandemic could affect long-term survival for many patients, a new Canadian study shows.
Among the challenges faced by Canada’s health-care system more than two years into the pandemic is the backlog of delayed surgeries and procedures that could take years to clear.
The new Canadian Medical Association Journal (CMAJ) study adds to the growing body of evidence examining the unintended consequences of the pandemic on patients with cancer.
“Although de-escalation of cancer surgeries during the pandemic may be required to protect vulnerable populations and create health-care capacity, these slowdowns are associated with a risk of unintended harm,” the study, published March 21 in the CMAJ, says.
Using real world data on cancer care from 2019 to 2020, the research examined the impacts of delays on those awaiting surgery before and during the first six months of the pandemic, with a focus on the province of Ontario.
The simulated model population comprised 22,799 patients waiting for cancer surgery before the pandemic and 20,177 patients during. The mean wait time for surgery before COVID-19 was 25 days, which was bumped up to 32 days during the pandemic.
The study looked at those receiving non-emergency surgery, including those with breast, gastrointestinal, genital and urinary, gynecological, head and neck, liver and gallbladder, lung and prostate cancers, and found that during the first half a year of the pandemic, a total of 843 years of life of cancer patients across Ontario could be lost as a result of delays.
“Although our model was a simplification of the diverse disease trajectories,” Dr. Kelvin Chan, the senior author of this study and a medical oncologist at Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, said that “the notable differences in survival by disease site” draws attention to the “need for measures of surgical prioritization during pandemic-related slowdowns.”
At the beginning of the pandemic, Ontario, like other provinces, asked its hospitals to ramp down elective surgeries so the province could prepare to curb the spread of the COVID-19 virus.
A report by the Ontario Medical Association last month found the backlog in Ontario alone was more than one million surgeries. Before Ontario’s second surgery shutdown, the association estimated it would take over two years to clean the backlog.
1:45 Terminal cancer patient speaks out against COVID-19 restrictions
Terminal cancer patient speaks out against COVID-19 restrictions – Feb 8, 2022
The new research estimated that 4,639 patients were on the waitlist for surgery on the first day of the pandemic in Ontario. This included 158 patients with liver and gall bladder cancers and 1,619 patients with genital and urinary cancers.
The study also estimated that 140 new patients would be added to the surgery wait list every single day.
“The health-care response to the COVID-19 pandemic in Ontario was driven by an intention to protect vulnerable populations of patients and reserve adequate health care resources to manage a potential surge of patients with COVID-19,” the study said. “We have shown the unintended consequences of this policy intervention in Ontario.”
“We showed variation in loss of life-years across cancer disease sites.”
With a hypothetical 60 per cent reduction in operating room resources for cancer surgery in the first six months of the pandemic, wait times increased up to 21 days, compared to pre-pandemic, the study found. This translates to an overall total of 1539 years taken off the lives of cancer patients across the province of Ontario.
Cancers with a higher risk of progression, like liver and gall bladder and head and neck cancers, were among the largest variation in life-years lost per patient.
Another study from the beginning of the pandemic, in part completed by Western University professor Janet Martin, projected that 28.4 million surgeries worldwide could be cancelled of postponed in 2020 alone.
Each additional week of cancellation could result in a further 2.4 million cancellations, the research said.
About 560,000 fewer surgeries were performed between March 2020 and June 2021 compared to the previous 16-month period through 2019, according to health data compiled and analyzed by CIHI for the report.
Ontario had a 76 per cent decline in surgeries in April 2020 compared to a year before — the sharpest drop of any province or territory in that hard-hit month.
Manitoba’s delay grew to over 161,000 diagnostic and surgical procedures as of mid-February of this year, according to Doctors Manitoba, a group representing the province’s doctors.
In Quebec, hospitals across the province had to reduce surgeries by about 50 per cent at the height of the Omicron wave. Dr. Francois Marquis, the chief of intensive care at Montreal’s Maisonneuve-Rosemont hospital, said Friday it will take months for the hospital to bring surgical waiting lists to their already daunting pre-pandemic levels.
“The hospital is not working full speed,” he said. “There are not enough surgeries, there are not enough patients being admitted. You still have rooms that are closed because we don’t have enough nurses and (respiratory therapists).”
Marquis says catching up is a challenge, given the number of nurses that have retired, left the field or transferred. But by working efficiently to streamline procedures, he’s happy to say that the hospital hasn’t cancelled a single surgery recently.
Last week, the Canadian Medical Association (CMA) and some 40 organizations representing health workers called for urgent government action to address issues facing the ailing system.
“While governments and Canadians are hoping to move past the pandemic, an exhausted, depleted health workforce is struggling to provide timely, necessary care to patients and make progress through a significant backlog of tests, surgeries and regular care,” CMA president Katharine Smart said in a statement following an emergency meeting.
“Careful management of health care resources is critical during times of resource constraint to mitigate unintended consequences,” the study echoed.
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
