Cancer is one of the leading causes of death in Canada, but during the pandemic physicians and healthcare providers have noticed a steep decline in new diagnoses.
“You wonder where some of these cancers are. Some of them are missing in action,” said Dr. Antoine Eskander, a surgical oncologist at Sunnybrook Health Sciences Centre in Toronto.
“We don’t know where they are. We’ve seen a drop in cancer incidence rates, despite there being a very steady rate of cancers being diagnosed in Ontario over the last three, four, five, 10 years.”
Part of the problem is people aren’t going to their doctors to get checked or screened, out of fear of getting sick with COVID-19.
By the time they do show up, experts say, their cancers are at a far more advantaged stage.
“So, when you say that COVID has had a profound implication on the delivery of cancer care, this is big,” said Dr. Lucy Gilbert director of gynecologic oncology at McGill University Health Centre in Montreal.
“We are seeing much more patients in what we call advanced unresectable stages.”
It’s a story that is all too familiar to Diane Van Keulen. Although the 61-year-old was diagnosed with stage four lung cancer before the pandemic hit, during the summer of 2020, she started getting sicker and sicker.
Unbeknownst to Diane, her cancer treatment wasn’t working. But because of COVID-19, she was too afraid to go to the hospital to get help.
As a result, some of Diane’s tumours tripled in size.
“I was my own worst enemy. I refused to go in for four weeks,” Van Keulen told Global News. “My body got, you know, became more broken. What would have happened if I went in at the beginning?”
“Would I be at less risk of progression? Because cancer does do that. Cancer does progress over time.”
Diane’s story and others like hers is exactly what concerns Dr. Gilbert. Despite stringent COVID-19 safety protocols, she said some patients who need help are staying away.
“People are so frightened of going and seeing doctors. The likelihood of catching COVID-19 from a health care facility is minuscule.”
“So please, please report problems in time. Have your tests in time. … I would like that message to go out.”
It’s a message many cancer associations across the country are trying to get out as well.
“We’re encouraging everyone to remain diligent with their cancer care. Follow up with your health care providers if you are due for a screening or treatment, and don’t delay if you are experiencing any possible cancer symptoms,” Tawny Barratt, the director of communications for Bladder Cancer Canada, told Global News in an email.
“I’m trying to be respectful of people’s fear. … But what I’ve learned is fear gets you nowhere, said Van Keulen, who is currently on an oral cancer drug to fight the disease.
“You’ve got to weigh the benefits, the pros and cons. In my case, … (there) were far more cons for waiting as long as I did learn my lesson.”
A recent U.S. study found nearly 10 million cancer screenings failed to happen in 2020 because of the pandemic.
The study, published in JAMA Oncology, examined the three cancers for which early screenings are critical: breast, colorectal and prostate. All three declined sharply, but the most significant was a 90 per cent decline in breast cancer screenings in April 2020.
One of the authors is Dr. Ronald Chen, chair of the department of radiation oncology at the University of Kansas Medical Center.
“As a physician, I wasn’t surprised to see that screenings had declined, but this study measures by how much,” Chen said during a news conference. “This study makes it clear that this is a large public health issue.”
At home, Canadian researchers are still gathering the data on screening tests, new diagnoses and oncology surgeries to understand the full scope of the puzzle.
Dr. Eskander is one of them. He said that he saw a 60 per cent drop in cancer-directed surgeries during the week of March 15, 2020, in Ontario.
“Over the next few months, we had an increase in the amount of surgery up by six per cent per week, but … we never hit pre-pandemic rates of cancer surgery,” Dr. Eskander said. “That was similarly observed for biopsies and for imaging. And cancer is not something that can wait.”
According to the Canadian Institute for Health Information, from March to June 2020, cancer surgeries were down 20 per cent across the country.
But for those who were sick enough to get their cancer surgery immediately during COVID-19, there have been tradeoffs.
Dawn Pickering’s seven-year-old son Oliver was diagnosed with anaplastic large cell lymphoma, a rare form of blood cancer.
To survive, he would need a stem cell transplant. Pickering said health officials turned to Canadian Blood Services to check the international stem cell registry.
“They found three perfect matches. So, we really felt like we had won the lottery, which was pretty incredible,” she said.
The relief was short-lived. Around this time, Canada went into lockdown. Oliver’s matches were international and because of travel restrictions and COVID-19 concerns, they weren’t able to donate.
The family was forced to turn to their daughter, Abby, who was a half-match.
“That certainly stressed me out quite a bit because now I have not just one sick child, but a second child who I have to make sure is protected and that nothing happens to her,” Pickering said.
“My parents didn’t pressure me at all,” said Abby Acosta-Pickering, who was 11 years old at the time. “His life was in my hands.”
“I was like, if this was Ollie, he would definitely do it for me because my brother is very kind, compassionate, empathetic guy and he’s always been there for me,” she added.
After many painful procedures and lots of COVID-19 safety precautions, Abby was able to donate.
“She was really kind to me and now since I’m well, we go back to brother and sister sibling fights,” Oliver Acosta-Pickering told Global News.
Oliver is doing much better these days. But he is one of the lucky ones who was able to fall back on his family for a donation. Other cancer patients haven’t been as fortunate when it comes to finding a match.
“I would say like COVID ruined everything,” said Sylvia Okonofua, who is the president of the University of Regina’s chapter of Stem Cell Club.
Okonofua has been working tirelessly to get more Black Canadians to register and donate stem cells. However, the pandemic has made recruitment particularly tough.
“We only got, let’s say, like a thousand recruited stem cell donors as opposed to getting like tens of thousands in previous years,” she said.
“Black Canadians make up less than two per cent on Canada’s stem cell donor registry,” said Okonofua.
These stem cell matches can be crucial for cancer treatment. So, experts are encouraging people to get informed and signed up. Even though the country is still in the third wave, healthcare staff are doing everything possible to keep people safe.
“I know they’re taking adequate measures to ensure that everyone is safe….who go through the donation process,” Okonofua said.
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