Published on April 9, 2020
Many cancer patients are finding themselves struggling to get care as hospitals across the country postpone or cancel surgeries and treatments to prepare for a surge in COVID-19 cases.
Federal and state governments as well as other organizations, such as the American College of Surgeons, have pushed hospitals to limit non-essential elective surgeries and procedures until further notice. However, the guidance gives local healthcare delivery systems the final decision on which surgeries and procedures can wait, advising them to take into consideration factors such as available staff, the age and health of the patient, the urgency of the treatment and the availability of personal protective equipment, ventilators and beds.
“… as we are in the midst of a whole-of-government effort to fight COVID-19, we need all our health care workforce and more to meet the demands of this challenge,” wrote Surgeon General Dr. Jerome Adams in USA Today. “Every non-urgent case takes precious staff time and energy, straining a workforce already going above and beyond in this fight.”
Cancer doesn’t sound “non-urgent,” but Dr. Len Lichtenfeld, Deputy Chief Medical Officer at the American Cancer Society, told NPR in a recent interview that he is hearing from patients across the country who are having chemotherapy delayed or surgery cancelled.
"There was someone who had a brain tumor who was told they would not be able to have surgery, which was basically, and appears to be, a death sentence for that patient," he said.
Christine Rayburn, 48, of Olympia, Washington, who was diagnosed with breast cancer in mid-February told NPR that she was notified two days before her scheduled lumpectomy that the procedure had been postponed indefinitely. The cancer had already spread to her lymph nodes.
"It just felt like one of those really bad movies, and I was being sacrificed," she said.
Sydney Loney, a Toronto-based writer and editor, found herself in a similar situation. She wrote about her cancelled mastectomy, lymph node biopsy and immediate reconstruction—an eight-hour procedure—in Chatelaine, a website for Canadian women. Loney was diagnosed with breast cancer in January.
“‘We could move four other patients through in that time,’ one of my surgeon’s assistants told me bluntly,” she wrote. “And, for one brief, terribly selfish moment, I didn’t care. I just wanted to go and bang on someone’s door and insist that I need this surgery.”
Dr. Catherine Liu, Associate Director of Infection Control at Seattle Cancer Care Alliance (SCCA), told Patient Power in an email that SCCA is working to ensure that most services are open and operating as normally as possible. However, the center has had to postpone non-critical appointments, surgeries and procedures for the protection of patients and staff, she said.
“… our physicians are providing thoughtful guidance for which patients should continue their treatment as previously scheduled and which may want to explore other treatment routes,” Liu said. “In situations where our physicians determine that scheduled surgeries or procedures can be delayed, they discuss with patients what alternative, non-surgical options are available and prioritize uninterrupted treatment.”
But non-surgical options are little consolation for someone like Loney.
After her cancelled procedure, her doctor sent her to the imaging department to book an ultrasound. The goal was to see how far her cancer had progressed since her last scan in January.
“Upon arrival, I was immediately told to come back in May—but not for an appointment, just to book one,” she wrote. She said she grappled with what to tell her children. She had reassured them that the surgery would make everything okay.
E. Alison Holman, an associate professor of nursing and health psychologist at the University of California, Irvine, suggests patients struggling to cope with delayed treatment reframe their thinking.
“I think one of the things people have to keep in mind is just how absolutely overwhelmed the health care system in this country is becoming,” she told Patient Power in an interview. “Think about postponing your elective surgery as a way of supporting the health care workers.”
“Right now, a lot of health care workers are very stressed,” she added.
Adams reiterated in his editorial that halting elective procedures is a temporary response.
“Deferring elective procedures does not mean they cannot or will not be done in the future once we see our COVID-19 response needs decrease," he said. "We are at a critical point in our global and national response to an unprecedented pandemic, and it will take sacrifice and an all-of-America effort."
Rayburn said she was preparing for months of chemotherapy (and isolation because of the resulting compromised immune system) when her surgeon called with news. She had convinced the hospital to allow the surgery.
As for Loney, her surgical oncologist has prescribed tamoxifen (Nolvadex or Soltamox) in an attempt to slow the growth of her tumor.
“The first time I met her, she was calm, reassuring and looked reasonably well-rested as she reviewed my breast cancer treatment options with me,” Loney wrote of her doctor. “She told me, ‘dying isn’t part of the plan.’ Now, I’m not entirely sure what the plan is.”
Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.
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