Canadian doctors say they are seeing patients with more advanced stages of cancer than usual — a phenomenon they are attributing to the COVID-19 pandemic.
Dr. Helmut Hollenhorst, senior medical director for Nova Scotia’s cancer care program, says he thinks cancer patients are presenting with more advanced disease due to pandemic-induced missed or delayed medical appointments.
“From my own practice, we see patients with more advanced disease,” Hollenhorst said in a recent interview, referring to the cancer care centre at the QEII Health Sciences Centre in Halifax.
“And we’re not alone on this,” he added. “This is all over the country.”
Firm data to prove this trend isn’t yet available, Hollenhorst said, but he said he is hearing anecdotal evidence from his colleagues across Nova Scotia and Canada about a rise in patients with more serious cancer.
“We do expect as data matures and becomes available we will be able to quantify this impact,” he said.
Dr. Tim Hanna, a non-melanoma skin cancer specialist in Kingston, Ont., says he started to notice a spike in advanced-stage cancer at his clinic in January 2021.
“I observed more advanced cancers among the patients I saw than I have personally ever seen,” Hanna said in an interview Wednesday. This trend lasted about a year at Hanna’s Kingston Health Sciences Centre clinic, he said, with rates of advanced cancer nearing normal in early 2022.
Most of the cancer types Hanna treats cannot be assessed on the four-stage cancer evaluation scale, but he said many of his patients between January 2021 and January 2022 presented with cancer that was more advanced than the type of cancer his patients normally present with.
Both doctors attribute the rise in advanced disease to how health care and peoples’ habits changed when the pandemic hit. For many people, primary care became less accessible, Hollenhorst said, adding that public health restrictions directed Canadians to stay home and avoid public places.
“Even if primary care was available, patients were worried about leaving the house or going to a hospital,” Hollenhorst said. This meant, he said, people put off visiting their family doctor or walk-in clinic to check on symptoms.
Advanced cancer ‘much more challenging to treat’
While treatment for cancer continued through the pandemic in much of the country, many diagnostic tests and screenings for cancer were temporarily paused when COVID-19 first hit Canada.
Hanna said temporarily halting these tests sent “a bit of an implicit message that cancer can wait.” He said this is a problem, because in some cases, “a missed screening could turn out to be a disaster.”
People with advanced cancer typically require invasive and complex treatment, Hollenhorst said, which means more harmful side effects for the patient. Some cancers, when caught early, can be treated with a single surgery, he said. But that same cancer, if diagnosed later, may require surgery in addition to chemotherapy and radiation therapy, he added.
The impact is “much more burden, hardship and struggle for the patients and much greater burden on the health-care system,” Hollenhorst said.
Hanna said for many cancer types, more advanced disease means the cancer spreads to other parts of the body. This makes it “much more challenging to treat, with greater risk of side effects and lower chance of success.”
The cost of delayed cancer diagnosis is also financial, Hanna said, adding that cancer drugs can cost around $10,000 per month. The health system must cover staffing and medical equipment costs for increased surgeries and treatments.
A study published in the International Journal of Cancer by McGill University cancer researcher Talia Malagon in November 2021 modelled the possible long-term impact of COVID-19’s disruption in cancer care. Malagon’s study predicted that the disruption in cancer care caused by the pandemic would lead to 21,247 additional cancer deaths in Canada between 2020 and 2030 — a death rate increase of two per cent.
Hollenhorst and Hanna said they hope ramped-up diagnostic screenings could decrease the number of additional cancer deaths predicted in Malagon’s study.
Hanna said he would like to see the province of Ontario offer greater reimbursement rates for family doctors to perform cancer biopsies. Hollenhorst said Nova Scotia, which has among the highest rates of cancer in Canada, should focus effort on cancer prevention and speed up cancer screenings.
“We need early detection and screening and then accelerated workup of suspected cancer diagnosis so patients are diagnosed at an earlier stage and enter the system quicker,” Hollenhorst said.
This report by The Canadian Press was first published June 9, 2022.