Cancer warriors and thrivers are familiar with the uncertainties of a medical crisis. Yet, while the COVID-19 pandemic continues to unfold across the globe, many have been left with a new set of worries.
For example, cancer is considered an “underlying condition” which can increase one’s severity of illness if they contract COVID-19. According to the Journal of the National Comprehensive Cancer Care Network, COVID-19 patients with cancer have a 3.5 times higher risk of needing mechanical ventilation, admission to the ICU or death than patients without cancer. That’s why most medical professionals across the country have opted to cancel or delay previously scheduled oncological surgeries.
Health systems across the country are canceling surgeries primarily to provide what us as doctors call our primary goal, which is to do no harm,” says Dr. Jonathan Bank, a New York based board-certified plastic surgeon and member of the medical advisory board for AiRS Foundation, a 501(c)(3) non-profit organization dedicated to financially helping breast cancer survivors pay for reconstructive surgery.
Still, learning you have cancer and delaying surgical treatment for that cancer can be a lot for one person to mentally and emotionally grapple with, especially during a time when the world at large has changed so dramatically. In this new interview with Cancer Wellness, Dr. Bank explains why hospitals are cancelling surgeries, why surgery doesn’t have to be the only option for oncological treatment, and what comes next for medical professionals and their patients.
Why are hospitals cancelling surgeries?
Depending on the specific condition and location in the country, if [medical professionals] feel that it is unsafe to bring patients into the hospital for things that are not emergent, they’ll postpone [surgery] as to not expose them to the risk of contracting COVID-19 and to minimize the exposure of the staff to new patients. [It also] reduces their risk of exposure and unburdens the system from dealing with cases that could be postponed when currently most of the resources at many hospitals across the country are being devoted to care for the surge of coronavirus patients.
People that have cancer at various stages are currently being postponed [from surgery] in order to provide care for people that really have imminent threats to their lives. Now with cancer patients, while we consider it an urgent surgery, it is frequently not emergent, meaning it’s not going to threaten one’s livelihood within a matter of hours or days, which is the timeframe for COVID-19 patients. So patients that have stage 0 or a low stage of cancer may be able to have surgery postponed. Patients that have slightly more advanced disease, particularly surrounding diagnosis around the breast, may be amenable to having chemotherapy or hormonal therapy and postpone their oncological surgery until it’s safe to do so. On rare occasions, cancer surgery is performed. This is what’s going on in my neck of the woods with very few exceptions.
I can’t speak for the rest of the country, but as the surge of patients hits more locations across the country, I think more health systems and hospitals and practitioners are going to align to this mentality. I can say that the American Society of Plastic Surgeons a couple of weeks ago came out with a statement that they recommend all elective surgeries be postponed. And they do give the option for the surgeon or hospital to weigh in [and] weigh the particular risks of that patient and that location. There is some leeway for the surgeons and the decision makers discretion, but in general, that has been the policy.
How long, by your guesstimate, do you think these postponements can take place while keeping cancer patients safe?
That’s the trillion dollar question. No one really knows how long this pause is going to be in place. I would say that it really depends on the stage of the disease. But I would say for the early-stage cancers, waiting something like a three-month period from diagnosis is something we’re going to have to accept. I can’t say if it’s safe or not, but that’s what I feel is going to take place. Hopefully at that point, we’ll be beyond the anticipated peak of the wave of COVID patients and after that, the hospitals will be more available to take care of urgent cases, followed by elective cases.
Active cancer, I’d say the best bet is to consult with the oncologist or the breast surgeon if it’s a breast cancer case and see what other options are available while we’re in this pause. Chemotherapy, radiation therapy, hormonal therapy, they’re all options for patients.
There are actually studies that completely choose the non-surgical approach for certain circumstances and that can be very valid in many cases. I would say for the majority of cases, surgery is still going to be what is preferred to do and the first line of treatment. But given the whole situation that’s going on around the world, we don’t have that privilege of going with our first choice and we have to go for second best at this point, which might be patient dependent, disease dependent. And then later, complete the treatment with surgery.
As a physician, what would you say to assuage patient fears that might have come up due to these cancellations?
There’s really no choice other than to look at this as the hospital trying to protect you. We’re trying to protect you. We’re not putting you in surgery. We know that it is reasonable to postpone surgery for a certain amount of time. We’ve never really studied how long it is safe to wait, but we definitely know it’s okay to wait.
There have been situations where we just couldn’t do surgery for all kinds of other reasons on other days. Meaning, the patient may have had other medical problems that preclude them from having surgery. Or they elected not to have these surgeries and chose a different path. And all of that’s valid. So I think that’s something that people can take consolation in, that surgery is not the end-all-be-all of cancer treatment. It is definitely an important component, but there are definitely other options.
Again, based on the person’s stage and specific situation, other options are most definitely available. Consultation with their oncologist [and] a treatment plan can be tailored taking this into account.
I’d say cancer for the most part doesn’t get out of control within a matter of days or weeks. When we go past the three-month mark, we start to get concerns. But I do think that the hospitals are very much aware of that. Once these few weeks go by, we’ll be able to make resources available and prioritize patients that are known cancer patients to be the first ones on the docket to have surgery. I know I for one and probably the rest of my team are going to work days, nights, and weekends and holidays to take care of as many people as we can, as soon as we can. And I feel many people around the country are going to do the same. We just have to make it safe for people first.