Do Not Allow Fear To Interfere With Your Health Care

Do Not Allow Fear To Interfere With Your Health Care

Mira Hellmann MD

The WHO (World Health Organization) declared the Coronavirus  outbreak a pandemic on 3/11/2020. This led to immediate action around the world aimed at decreasing the spread of infection. Many different recommendations have emerged regarding safety and precautions that are necessary in order to slow the spread of the pandemic and to save as many lives as possible. Furthermore, fears of collapsing the healthcare systems resulted in recommendations that reserved much of the system’s resources for management of patients diagnosed with COVID-19. Various cancer societies around the world put together suggested guidelines regarding the care and management of cancer patients during this pandemic. These recommendations were derived from data from China that indicated a significantly higher risk of coronavirus in patients with active cancer, and potentially in patients with a history of cancer. In some reports cancer was noted to be present in up to 20% of coronavirus infected patients. Mortality also appeared to be higher in active cancer patients, with a mortality rate of 2.3% in the overall population versus 5.6% in the active cancer patient population. These recommendations resulted in a precipitous drop in patient visits to the doctor. For patients who do present for treatment, modifications to standard treatments were recommended, such as withholding surgical or chemotherapy interventions in slower growing cancers, and modifying management in more aggressive cancers including increasing use of outpatient therapies and non cytotoxic therapies in lieu of surgery or cytotoxic chemotherapy.

This started six weeks ago. We have now learned more about the disease, its pattern of spread, and most importantly its anticipated trajectory. As more data emerges the likelihood of this pandemic ending abruptly; and thereby resulting in a rapid reopening of all services and resumption of normal standard of care,  is rapidly decreasing. As time progresses, the concern for rising rates of adverse non COVID outcomes, such as cancer, become more acute. Some have dubbed this the distraction effect. The extent of this effect is currently unmeasured, but with further delay in care the magnitude of this effect will continue to grow. According to the American Cancer Society 5,000 new cancer cases are diagnosed daily in the US. Given the current restrictions with access to health care, many of these cancers are going undiagnosed. Many cancers, including ovarian cancer and high grade endometrial cancer, as well as other solid and liquid tumors,  are time sensitive in terms of  treatment urgency and its effects on cancer outcomes. According to a report published in Reuters 4/28/2020 rates of screening tests for various cancers, including cervical cancer,  have plummeted in the United States since mid March, with a notable drop of 68% nationally, and even higher in coronavirus hotspots. Since we have gained more insight into the disease, we have managed to institute measures that increase safety of delivery of care, at the same time avoiding compromising the quality of the care. Universal masking measures, both for patients as well as providers, symptoms screening, including screening of contacts, and more readily available swab testing, amongst many other measures, have dramatically improved the safety of delivery of care. Telehealth, although useful in some situations, lacks physical exam, which is integral  to evaluating gynecologic malignancies.  I am urging all patients to be proactive about their cancer care, and ensure that they are not having their cancer care compromised.  Please go to your doctor, or find a doctor who will see you. Please do not allow fear to interfere with your health care.

Stay healthy, stay safe.

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