Healthcare’s adherence to mandated government restrictions for the COVID-19 pandemic has forced physicians and hospital leaders to make difficult choices.
Some patients needing surgery, such as for an organ transplant or to remove a tumor, are being asked to wait, depending on the immediate risk factors and their case conditions. Even patients coming into the emergency room are checked for the COVID-19 virus, lest they inadvertently infect the staff and others. While the precautions are for everyone’s safety, it creates a present and future dilemma.
No one questions the need to treat sick patients. COVID-19 is a scourge on the world. The death toll, the effect on hospitals and healthcare workers, the strain on individuals and families, all has been heartbreaking. Add the restrictions on freedom and the economic pain it has caused to businesses, it is just a terrible situation.
For oncologists, the effect has been disproportionate. Their job is to fight cancer, which itself is a killer disease.
With elective surgeries being forced to reschedule, the question is how we are deciding what is truly elective. Critical surgeries are still performed when the life of the patient is in immediate danger. Some patients and their families wait for the green light to enter the operating room for tumor resection.
When care includes surgery, immunosuppressive therapy and inpatient treatment, the safe route is to wait for the curve to flatten, since cancer patients can be immunocompromised. There is, however, always a risk of patients dying from cancer as they keep clear of COVID-19. Additionally, there is an economic impact as well. Oncologists who don’t see patients don’t get paid. Some practitioners’ practices are struggling and considering closing. With a pre-existing physician shortage in general and oncologists specifically, these factors could spell difficulties down the line.
Only about 10% of surgeries normally performed are being performed now. With more than a million surgeries typically performed every month, the backlog will create ripple effects for every scheduled surgery on the calendar. Cancer is not pausing because of the coronavirus. Heart disease is not pausing, either…and so on.
The American Society of Clinical Oncology projects a shortage of more than 2,200 oncologists by 2025. Meanwhile, this year approximately 1.8 million people will be diagnosed with cancer in the United States. The rate of new cases far outpaces the number of younger clinicians replacing the retiring ones.
Cancer care and research took a hit during the pandemic and will experience many challenges in a post-pandemic world. However, there will likely be opportunities as well. The ASCO is working on guidelines that asks a core question: “What changes to care delivery and clinical research, implemented in response to COVID-19, should or should NOT be retained once the pandemic recedes (and why not)?”
The ASCO guidelines could be a blueprint for current and future oncologists in the New Normal. However, let’s keep our eyes on the ball. Once elective surgeries are reinstated, improvements in safety measures will be needed to keep patients and providers safe along with empathetic oncology specialists who can tackle the growing cancer rates with training and dedication.