The danger of waiting to get cancer care is far greater than the risk of exposure to COVID-19.
No matter how you say it—between a rock and a hard place, the lesser of two evils, between the devil and the deep blue sea—there’s a reason the old adage exists, especially now. As we continue coping with the Coronavirus pandemic, we face decisions that force us to weigh out risks. Should we forgo fresh produce to avoid too many trips to the grocery store? Should we shop online and put delivery drivers at risk?
In many instances, the risks and rewards seem easy enough to determine but when it comes to health and seeking care, the decision can be more difficult. Results from a poll conducted by the American College of Emergency Physicians and Morning Consult revealed that 29 percent of Americans have delayed or avoided medical care during the COVID-19 pandemic out of fear of the virus. Numerous media sources report that emergency room visits have decreased by as much as 50 percent across the country.
Outside of the ER, patients may not have had the opportunity, or perhaps the burden, of choosing whether to see a doctor. Following recommendations from the CDC, all 50 states enacted restrictions or prohibitions of elective surgeries, procedures and visits.
Fortunately, the curve is beginning to flatten across the country and appointments are being re-scheduled. While many patients have been expectantly awaiting their chance to have a swollen elbow or a chipped tooth examined, others may let fear get the best of them and ignore a lump, pain or another symptom—and the latter choice can lead to serious consequences.
"While the coronavirus has brought many activities to a halt around the world, there is much that has kept moving. Across the US, spring is burgeoning, and flowers have bloomed; natural processes continue despite any shutdowns or societal stillness. Unfortunately, this is also true for more insidious developments. As we have seen at Karmanos Cancer Institute, cancer isn’t waiting for the coronavirus to pass.
Herein lies the conundrum. While the coronavirus poses many risks, the danger of missing early diagnosis can be far more consequential. Patients who delay care or negate screening may be in danger of missing treatment before it’s too late.
Early detection saves lives
The American Cancer Society (ACS) recently reported a 2.2 percent decrease in the overall U.S. cancer death rate earlier this year—the largest recorded single-year drop, which contributes to the resounding 29 percent reduction in cancer deaths from 1991 to 2017. Although many factors contribute to this decline, cancer prevention and early detection are central to improved patient outcomes. According to the ACS, additional cancer morbidity and mortality could be prevented by reducing disease risk factors and increasing cancer screening uptake.
As we know too well, survival outcomes depend largely on the cancer stage at diagnosis. For breast cancer, the five-year survival rate is 99 percent for tumors located within the breast. This rate drops sharply to 27 percent once the cancer has metastasized to distant parts of the body such as the lungs, liver or bones. When it comes to lung cancer, if a tumor is detected early (still contained within the lung) the five-year survival rate is about 56 percent, but if the cancer has spread to other areas of the body, that rate drops to 5 percent.
"Early detection is a key factor in the rate of breast cancer survival and it is the one that we have the most control over," said Michael Simon, M.D., MPH, co-leader of the Breast Cancer Multidisciplinary Team at Karmanos Cancer Institute. "With the information and technology we have available today, breast cancer screening is saving many lives."
When early detection is key to survival, how do we encourage cancer screenings amid COVID-19?
Prepared for this challenge
Public facilities across the country have put measures into place to ensure that patients and customers are safe from the moment they step through the doors. Implementing them has meant adapting quickly and enforcing difficult rules for all, but some places have proven to be better equipped than others.
As a NCI-designated comprehensive cancer center, Karmanos Cancer Institute has been following stringent safety protocols since well before the pandemic began. In fact, heightened awareness is a part of the requirements every day. Since many cancer patients are immunocompromised, either from their disease or from the treatment they are receiving, wellness and prevention have always been top-of-mind.
“When patients are diagnosed with cancer, we give very good instructions about avoiding risks. For instance, every year with the flu season, we limit visitation to our facilities. In the past, we didn't have the term 'social distancing' as we do now, but we encouraged that practice when it was appropriate, along with hand washing and regular communication with healthcare providers,” explained Dr. Simon.
Practices that the public has now adopted are old hat for many cancer patients, proving that proper precautions really do work. With some added awareness, those being treated and the providers that care for them can weigh the risks and the result is clear: the danger of waiting to get cancer care is far greater than the risk of exposure to COVID-19.
References:
American Cancer Society. Facts & Figures 2020 Reports Largest One-year Drop in Cancer Mortality. https://www.cancer.org/latest-news/facts-and-figures-2020.html. Accessed May 18, 2020.
American Cancer Society. Cancer Prevention & Early Detection Facts & Figures 2019-2020. Atlanta: American Cancer Society; 2019.
American Cancer Society. Survival Rates for Breast Cancer. https://www.cancer.org/cancer/breast-cancer/understanding-a-breast-cancer-diagnosis/breast-cancer-survival-rates.html. Accessed May 18, 2020.
American Lung Association. Lung Cancer Fact Sheet. https://www.lung.org/lung-health-diseases/lung-disease-lookup/lung-cancer/resource-library/lung-cancer-fact-sheet. Accessed May 18, 2020.
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