In the spring, Dr. Melissa Brackmann made difficult calls to her patients in Michigan, telling them they had to delay their cancer surgeries because of the rising COVID-19 cases in the state.
Now, as Brackmann watches Utah’s coronavirus spike while working as a gynecologic oncologist in Salt Lake City, she’s encouraging her patients to schedule their surgeries as soon as possible.
“We don’t know," she warned, “what the coming days and weeks will bring.”
Brackmann worries that Utah could see a similar situation to what she experienced in Michigan, and that hospitals could be forced “to delay care for everything except life-threatening emergencies — including cancer care.”
Utah again set daily records Friday with 2,987 new coronavirus cases, 395 people currently hospitalized and 17 deaths.
Local health systems can prepare for these increases in patients, Brackmann said, but it’s “really in the public’s hands so much more than they know."
To make sure cancer care isn’t potentially affected in Utah as the pandemic stretches on, people need to wear masks and think about what activities they’re engaging in and what type of socializing is really essential in their lives, she said.
“I get it. People are frustrated,” said Dr. Thomas Varghese, a thoracic surgeon and interim executive medical director at Huntsman Cancer Institute. But getting Utah’s cases under control requires everybody’s help, he said.
Varghese worried about how the pandemic will affect cancer care, if people aren’t going for their regular screenings, such as mammograms and colonoscopies.
It’s important Utahns still do that, he said. “The cancer is not just going to sit there."
In March, Utah hospitals temporarily delayed nonessential treatments as health officials prepared for a surge in coronavirus cases. People with time-sensitive conditions, such as cancer, largely continued to get care.
What has helped, said Dr. Mark A. Lewis, director of gastrointestinal oncology at Intermountain Healthcare, is the ability to move patients among hospitals and clinics so they didn’t get overwhelmed.
Plus, not all cancer care requires a lengthy hospitalization, Lewis said. Most of his work is actually outpatient.
It’s when a hospital’s capacity gets overrun that “decisions sometimes get made for us” in terms of what surgeries can be done, Brackmann said. There not only have to be enough beds in the intensive care unit, Lewis added, but also the doctors and nurses specialized in that care.
Michigan saw a steady rise in cases through May, leading to a backlog in surgeries, the Detroit Free Press reported. Brackmann, who was finishing her fellowship in southeast Michigan in the spring, estimates her gynecologic oncology group “went from 15 to 20 cancer surgeries per week to few or sometimes none," with delays in chemotherapy, radiation treatments and imaging studies.
“It was really hard” and “unsettling,” Brackmann said, to tell patients “we couldn’t do their surgery” and “we didn’t know when we were going to be able to.” For the most part, though, patients were “very understanding,” she said.
Still, getting a cancer diagnosis is stressful, and patients were anxious, Brackmann said, about how a delay would affect “their ultimate outcome” — survival.
Plus, doctors knew less about COVID-19 in the spring, so patients were worried about catching the virus during their recovery after surgery. Now, in the fall, doctors have a much better understanding of the virus and what needs to be done to address it, Varghese said.
As a gastrointestinal oncologist, Lewis said he’s spent his career helping patients balance the risks and benefits of cancer care. COVID-19 adds another element to that.
There has been “a substantial decline in cancer screening” during the pandemic, according to the American Cancer Society, which makes Lewis and other doctors worry about the people who “could end up losing their lives in the years to come from cancers that could’ve been prevented right now,” he said.
In June, Norman Sharpless, the director of the National Cancer Institute, said there may be “10,000 more breast and colorectal cancer deaths over the next decade than would have been expected without the coronavirus,” and that’s based on a “conservative” analysis, according to The Washington Post.
It’s important to detect cancer in the early stages, Varghese said, and he encouraged people to still go for their screenings right now. Doctors have the supplies to make sure this is done in a safe environment, he said. “We know that screening saves lives."
Utahns should also be conscious of people in their community who have long-term illnesses as they think about how to properly practice social distancing, Lewis said. Many cancer patients “are not bald” or visibly sick, as some might expect.
People need to wear masks and distance themselves from others “not just for their own protection," Lewis said, "but for people around them that are … dealing with a serious illness.”