Diagnosing and Treating Cancer during the COVID-19 Pandemic Special Committee on Beating Cancer @ European Parliament World Cancer Day 2021
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Diagnosing and Treating Cancer during the COVID-19 Pandemic
Special Committee on Beating Cancer @ European Parliament
World Cancer Day 2021
Seamus O’Reilly BSc MD PhD FRCPI
Cork University Hospital and University College Cork, Ireland
seamus.oreilly@hse.ie
Living with Cancer during a Pandemic • Fear of COVID-19 and Constant cocooning to avoid it • Loss of Supports • Financial Worries • Isolation
COVID-19 Associated Changes @ CUH Cancer Centre
• Infrastructure
– Alteration to Hospital and Day Wards
– Private Hospitals taken over by the State to increase capacity
• Information Sharing Nationally and Internationally
• Cancer Clinical Trials
– Hold on new enrolments
• Support Services
– Irish Cancer Society Daffodil Centres and ARC Cancer Support House closed to physical
visits and virtual consults introduced
• Cancer Screening
– Bowel and Breast Cancer Screening stopped
• Staff
– Reassignment of Cancer Liason, Clinical Trial and Cancer Genetics Nurses
– Reassignment of Doctors in Training, ICU Education of Non-ICU staff
• Patients
– Virtual Clinics, De-escalation/Deferral of Therapy,
– Modification of Radiotherapy
January 2021: Extreme Staff Loss in all
Departments leading to Service Disruption
and Challenges to Organising Cancer Care
Percentage of Staff in isolation due
to COVID-19 related issues
60,00%
52%
50,00%
Percentage of Staff
40,00%
30% 33% 30%
30,00% 25% 25% 26%
18% 20% 18%
20,00%
12% 14% 13% 13%
10,50%
10,00% 5%
1% 0% 1%
0,00%
Data sourced from the Line Managers in each Dept CUH 20/01/2021
Delaying Surgery by 6 weeks in Patients with Lung and Pancreas
Cancer Reduces Survival
Khorana AA, Tullio K, Elson P, Pennell NA, Grobmyer SR, et al. (2019) Correction: Time to initial cancer treatment in the United
States and association with survival over time: An observational study. PLOS ONE 14(4): e0215108.
https://doi.org/10.1371/journal.pone.0215108
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0215108
The impact of 6 months Service Disruption
Increases Deaths for the Next Decade
Norman E. Sharpless Science 2020;368:1290
Copyright © 2020 The Authors, some rights reserved; exclusive licensee American
Association for the Advancement of Science. No claim to original U.S. Government
Works
Impact on Cancer Care 2020 • 2000 cancers lost due to service disruption because of an initial fall of 36% in referrals to rapid access breast, lung and prostate clinics • Cancer Trials 40% reduction in activity (www.cancertrials.ie) • Chemotherapy and Radiotherapy access not affected • Breast Cancer Screening closed for 6 months • Cervix Cancer Screening – 80% non-attendance • Cancer Genetics Services curtailed • Cancer Counselling Services sustained virtually (www.corkcancersupport.ie)
In Ireland 1000000 cervix screening appointments made:
only 20000 were kept
This diagram shows that if you stop Cervical Cancer
Screening mortality quadruples
The Lancet 2004 364, 249-256DOI: (10.1016/S0140-6736(04)16674-9)Impact on Health Care Workers
Some of things that I have done or felt during the Pandemic, and that I don’t want experience again • Praying that a COVID swab is negative so that a patient can die with unrestricted family visiting • Telling a patient that she is dying when dressed in full PPE with no family present • Making patients feel (more) isolated during consultations with them by focusing on Time with them and Distance from them • Calling patients to delay life saving treatment because of COVID 19 related issues • Worrying that a patient/family member will contract illness from me • Not being able to console
• COVID-19 is an inhuman disease because it simultaneously causes illness and isolation • It has disrupted cancer care and magnified cancer related suffering for patients • It will increase cancer mortality in the EU for at least the next decade.
• In the short term The European Parliament can help by
– Accelerating COVID-19 vaccination roll-out
– Developing a community wide Catch Up Programme for Cancer
– Funding studies on the impact of COVID illness on cancer
treatments
– Reinforcing Mental Health Supports for Patients and Healthcare
Workers
– Work force planning to address the 1 million European
healthcare worker deficit that existed before the pandemic
– Developing a citizen specific European Health Care Number
• In the long term the European Parliament can help by
– Strengthening Public Health and Health Promotion to reduce
the impact of both future pandemics and cancer incidence in
the CommunityArticles of Interest
Articles related to Health Care
Articles Related to Patients Workers
• Long haul COVID-19 and skin • Faraz S ; National Public Radio May
of colour The Lancet Voice 16th 2020 www.npr.org
podcast 4/9/20 • Running on fumes. Trappey BE.
JAMA
• The COVID long haul Today in doi:10.1001/jama.2020.17249
Focus podcast. The Guardian • The Shape of the Shore Awdish R.
10/8/20 (www.theintima.org)
• “A Hard Time to Die” Boland • This Level of Death, its new. Veria et
MJ Sunday Miscellany 5/4/20 al JAMA 325:331-2.2021
www.rte.ie • Intensive Care: a GP, a community
“Mourning our dead in the and COVID19. Francis G Profile
COVID19 pandemic” Books 2021
O’Mahony S BMJ. 2020 Apr • Physician Deaths from Corona Virus
27;369: COVID-19 disease. OccMed doi
10.1093/occmed/kqaa088Thank You Patients with Cancer & their families Colleagues in CUH, MUH SIVUH and WUH Cork ARC and Cancer Trials Ireland. My family for their support.
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