Cancer care disrupted for almost half of patients

Australians say their treatment and screening has been delayed or postponed, and psychological support is sorely needed.

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Around half of cancer patients have suffered disruption to their care during the pandemic, according to a survey of 1000 Australian patients and healthcare workers.

Of most concern to the patients was the lack of psychosocial support, the PLOS ONE study found.

A third of the 683 patients and survivors included in the study indicated they had to reschedule appointments, 10% reported having treatments postponed and 12% said their planned screening tests had been rescheduled.

A further 7% had elective surgeries delayed.

“[My] annual check-up with the surgeon was postponed for the duration. I had my annual mammogram prior to this … had to assume that the results were OK as no one contacted me,” said one survivor.

“Due to social distancing the <hospital name removed> put my treatment on hold. This has been very stressful,” a patient reported.  

Fears of contracting covid have also played a role in the anxiety some patients experienced.

“[I have] anxiety at medical check-ups when staff need to be very close; for example, biopsy, examinations. Less likely to see GP face to face for minor issues; for example, skin issues that cannot be dealt with via telehealth,” one patient told researchers.

“[I am] fearful of attending appointments for X-rays, ultrasounds even if they are only yearly follow-ups for my breast cancer,” said a survivor.

The study, which was led by Cancer Council NSW and University of Sydney cancer researchers, found that almost half of the 150 health care workers agreed there were atypical delays in delivering cancer care and half said access to research and clinical trials had dropped.

Some said they were concerned about the long-term effects of this on patients’ cancer prognosis.

“Very concerned about the reduction in diagnosed cases and what that will do to our patients and us over the next five years,” said one healthcare worker.

One in three said such changes to diagnostic procedures or pathways made them suboptimal.

One major theme that emerged was concern over the increased pressure the pandemic placed on patients’ wellbeing.

“Definitely noticed patients undergoing cancer treatment feel vulnerable to severe covid infection and are more likely to go to extreme measures to isolate with subsequent increase in anxiety/depression/loneliness/job loss/financial and relationship strain,” said one healthcare worker.

“Covid-19 and the associated impact of this has been an overlay that has affected every aspect of work — more complex patient interactions, more complex workplace interactions (and my own personal capacity to deal with challenges has been reduced),” said another.

One of the biggest challenges for patients was the limit on support people they could bring to appointments.

“While I’m always afraid, I am more afraid as to the treatment as I think my husband won’t be allowed [to attend the appointment],” said one patient.

Amid these challenges, community support organisations also experienced funding squeezes and were forced to reduce their services, the authors said.

Despite these disruptions, 61% of patients, survivors and carers said they felt fully informed about changes to cancer treatment plans, and more than half didn’t wait longer than usual for appointments.

And three in four healthcare workers said they felt satisfied with the quality of care provided to cancer patients over the pandemic.

The study authors “strongly encouraged” the adoption of recent guidelines designed to provide “practical strategies for clinicians to employ with patients, caregivers and family to address the uncertainty associated with their care”.

The researchers also praised the role of telehealth and indicated that an iteration of the telehealth model should be made permanent.

“The rapid implementation of telehealth within cancer services – the adoption of which has previously been slow and fragmented across jurisdictions – has largely been successful and may offer permanent value in enhancing cancer care quality and access, as well as provide innovative and highly acceptable solutions to crisis preparedness and response strategies,” they wrote.

PLOS ONE 2021, online September 17