Surgical delays due to COVID-19 could lead to shorter life spans for cancer patients: study - CTV News Toronto | Canada News Media
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Surgical delays due to COVID-19 could lead to shorter life spans for cancer patients: study – CTV News Toronto

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Longer wait times due to the slowdowns of cancer surgeries during the COVID-19 pandemic in Ontario will likely lead to decreased long-term survival for many patients with cancer, a new study has found.

As the province quickly pulls back pandemic restrictions and the health-care system steams ahead, a research paper published in the Canadian Medical Association Journal on Monday revealed the impact of the Ontario government’s decision to reduce the number of cancer surgeries, along with other elective surgeries, performed in the province during the first COVID-19 wave.

“This research paper used real world data, combined with a simulated model, to demonstrate that delays in surgery in our health-care system in Ontario are likely going to lead to changes in survival for cancer patients in the future,” said Dr. Tony Eskander, a surgical oncologist at Sunnybrook Health Sciences Centre and a lead author of the report.

The province’s decision to reduce the number of elective surgeries was made in anticipation of a potential surge of patients with COVID-19. The study states that while necessary at the time, the strategy resulted in a backlog of cancer surgeries, and some patients faced longer wait times for surgical treatment.

The study focused on patients receiving non-emergent cancer surgery in Ontario. It included patients with breast, gastrointestinal, genitourinary, gynecological, head and neck, hepatobiliary, lung and prostate cancers.

The study uses a microsimulation to analyze the long-term consequences of the pandemic-related surgical delays. It looks at the 22,799 patients who were waiting for cancer surgery before the pandemic, and then looks at the waitlist of 20,177 patients during the pandemic, and the research team subjects them to different wait times.

“We subject them to what the regular wait times are, which on average prior to the pandemic, was about 25 days, and then the pandemic wait times, which on overage when the pandemic started was about 32 days,” Eskander said.

“Seven day difference seems like a very small difference, but when we took those patients and we put them through out health system in the model, we identified that those additional waits actually led to changes in survival.”

Eskander noted that all patients with cancer in Ontario, overall, lost a combined 843 life years due to surgery delays in the first wave of the pandemic.

“And, we only really modeled the first wave. We only really focused on the first six months of the pandemic so that number is probably much greater because we have subsequent waves with subsequent slowdowns,” he added.

The study also highlights that the results reported in the research paper are likely conservative estimates of the true impact of the COVID-19 pandemic on outcomes of patients with cancer.

The study noted while de-escalation of cancer surgeries during pandemics may be required, the slowdowns are associated with a risk of “unintended harm.”

“Careful management of health-care resources is critical during times of resource constraint to mitigate unintended consequences,” the study concluded.

Looking at the big picture, Eskander added the Ontario government should focus on a “holistic approach” that builds capacity in the health-care system, such that “even when our health-care system is pressed, we have the ability to continue with life saving and absolutely needed surgery.”

“In reality, in Ontario, our hospitals prior to the pandemic were already running at 100 per cent,” he said. “We’re still stuck trying to catch up and prioritize patients … What we really want to do is to create capacity in the system, where patients who need surgery should have free and open and equal access to it.”

“The only way to do that is to build more hospitals, build more operating rooms and provide more access to surgery in the health-care system.”

CANCER DIAGNOSIS FALLING THROUGH THE CRACKS

Eskander stated that another issue recognized in the study is many individuals are not even getting their cancer diagnosed in the first place due to pandemic-related issues.

“We’re behind even on picking up on cancers and even getting them through to treatment,” he said. “We know that there’s a number of cancers that are being diagnosed at a far lower rate than we would expect from prior to the pandemic.”

He said that often times cancers are diagnosed by accident on scans, including CT scans, MRIs and ultrasounds, but during the pandemic this imaging was not used as frequently as before due to disruptions in the health-care system.

He added that screening programs, which are meant to pick up on cancers during an early phase, were also disrupted during the pandemic.

“We still have a backlog. We haven’t quite caught up on our screening, but presumably as we catch up, we’re going to have a massive wave of cancer patients coming through the system,” he said.

Eskander added the final, and probably most important reason why cancer diagnoses are not happening as often as usual, is the lack of in-person medical appointments.

“I think virtual care is important and it’s here to stay, but I think seeing physicians virtually only, or predominantly, is a problem,” he said. “Because a lot of cancers that otherwise would be seen by a physician or felt on physical examination are missed and caught at a later time.” 

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Canada to donate up to 200,000 vaccine doses to combat mpox outbreaks in Africa

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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.

The Canadian Press. All rights reserved.

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How many Nova Scotians are on the doctor wait-list? Number hit 160,000 in June

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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.

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Newfoundland and Labrador monitoring rise in whooping cough cases: medical officer

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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.

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