By Lori Roa RN
Kristi Davis, an otherwise healthy 45-year-old woman and single mother of 4, was diagnosed with triple negative breast cancer in January. Her experience has been somewhat different than previous years due to Covid-19.
“On January 13th, I found out my oldest son had covid. About an hour and a half later, I got a call that I was diagnosed with cancer. The next day, I found out that my daughter had covid as well,” Davis shared. “Due to the diagnoses, I could not see anyone about the cancer for 14 days. Waiting for the appointment was hard.”
Kristi’s medical team wanted to see her as soon as possible, but did need to adhere to current Covid-19 protocol. She was seen the first day that protocol would allow. She would go on to experience several more delays before starting treatment, bringing her to 6 weeks before getting treatment.
“I also had to first go through covid screenings before getting a chemo port placement, as well as a sentinel node biopsy- which meant an additional test and another delay,” Davis states. “They had to have the lab results before I could have surgery.”
Davis is one of many who have experienced increased hurdles to getting medical care the past year. While Covid-19 has become a regular topic of discussion quite literally impossible to ignore, cancer remains as big of a threat as ever, and even predicted to be a growing threat in the coming years.
Why Are Cancer Cases On The Rise?
According to the Epic Health Research Network, there was between an 86% and 94% drop in preventative cervical, colon and breast cancer screenings across the country in 2020 when compared with 2017-2019. This means an incredible drop in the number of cases diagnosed, and an incredible number of cases that have progressed undetected.
Oncology medical professionals would agree that prevention is always better than treating. However, the pandemic caused an enormous gap in the efforts of early detection. As doctors’ offices began to close down in early 2020 to take precautions during the growing pandemic, they also began spacing out cancer screenings. Patients who went in for appointments every three months were now being pushed back to six months. Some forwent the screenings altogether in fear of going into hospitals overrun with covid patients. A diagnosis would not be made if a screening never took place.
While screening and prevention remain the core issues, other obstacles compounded the ability to receive services. Those that need transportation were at a disadvantage. Calling a friend or family member was not always an option between social distancing, ride share services, public transportation and other medical risks associated with social interaction required during transport. Offices began leaning towards virtual appointments. Access to technology and the ability to use technology impacted the decision to make virtual appointments. If you did not own a vehicle or computer, on top of your regular doctors not taking in person appointments, the likelihood of a regular screening went down significantly in the past year.
When Covid 19 made its way to Davis’s town, she took precautions but went about her daily life. She went to her mammogram appointment last June, which came back normal- a false negative. Her screenings and doctor appointments were delayed, but she went when she could get scheduled. After a breast biopsy at age 33, she takes her screenings seriously.
Those undergoing treatment also face new obstacles, such as increased risk when doing daily errands or seeing loved ones who may be in busy workplaces.
Now that Davis has started chemotherapy, she is much more concerned about going to public places. While Davis feels that the importance of receiving her treatments outweigh the risks of going to her appointments, the risk and fear of Covid could potentially deter or delay some from getting treatments that further compromise their immune system.
“I don’t do appointments unless they are absolutely necessary, or I will ask if there is a way to do non-oncology appointments over the phone or internet,” she says. “I don’t feel so free to just walk into a store or the hospital if I need something. The only way I know to stay safe now is to stay home.”
Cancer is not novel, but it remains a deadly contender. The American Cancer Society predicts there will be an estimated 608,570 deaths due to cancer in the United States in 2021, predicting a short-term drop-in diagnosis following an increase in late-stage diagnosis and preventable cancer deaths. The CDC has counted over 560,000 Covid deaths since January 21, 2020, making cancer an oncoming contender in causes of death. These numbers do not take into account the effects of cancer, or cancer treatment, during Covid 19 onset. While these numbers offer predictions for the next year, Norman Sharpless, director of the U.S. National Cancer Institute, reports the effects of Covid-19 on cancer screenings data could suggest nearly 10,000 excess deaths from breast and colorectal cancer over the next decade when compared to previously expected data.
Organizations which serve cancer patients have already seen an increase in clients. Cancer Companions, a Christian cancer ministry, has seen the need for their services increase of 157% since last year.
Can We Change The Outcome?
Globally we are working to change the way we approach healthcare while attempting to end the pandemic. The Epic Health Research Network data in 2021 shows screenings are beginning to rise with the onset of Covid-19 vaccination availability. Specifically, The U.S. National Cancer Institute has worked with the U.S. Food and Drug Administration to increase access, flexibility, and support for clinical trials, such as offering more remote services. In addition, more clinical trials addressing the relationship between Covid-19 and cancer are being funded. The more we know about the relationship, the safer we can make hospitals, screenings, and treatments. When the public feels safe, our screenings and diagnostic testing will continue to rise.
On the local level, practices are making adjustments, as well. Many patients have received more in home health visits, including injections and blood lab draws that previously would have been office visits. Office visits are reserved for necessary testing that cannot be done remotely or at home, such as CT or MRI.
Davis has had more appointments now than ever before. She is glad to have the continued health safety measures, but hopes to see evidence based decisions made on necessary protocol in the future. “I don’t think anyone should feel they can’t go to the doctor due to someone else being careless with protocols. The clinics and hospitals are clearly doing all they can to protect the patients as well as themselves, which I appreciate. I know it has not been easy on either side.”
Graph from Epic Health Research Network, depicting years 2017, 2018, 2019 and early 2020 Breast, Colon and Cervical Cancer screenings