Health, Patient Impacts on 'Elective' Surgery Postponement During COVID Emergency

"That's [postponement of elective surgeries] been a massive problem for patients. You can imagine how anxiety-provoking a cancer diagnosis is at the best of times, let alone during COVID-19 ... and then on top of that they have uncertainty about when they can have their surgery."
Dr.Chris Booth, oncologist, professor, Queen's University

"Sad comment: It will become more and more difficult to reassure our patients about the impact of this delay on their prognosis."
Dr.Diane Francoeur, president, Quebec Federation of Medical Specialists

"This is the great stress. If you have a stage-three cancer or stage-two that is still operable, you can wait four to six weeks. But if you finally get operated on four months later, maybe it's not operable any more, maybe it's progressed to a stage-four cancer."
"At the beginning, we do feel that other patients were completely forgotten and abandoned. They don't want to be sacrificed in the name of COVID patients."
Eva Villalba, Quebec Cancer Coalition

"The people who do come to hospitals are sicker."
"That's because they started getting sick and they waited until they were desperate to come in."
Dr.Andrew Krahn, president, Canadian Cardiovascular Society, Vancouver

Non-urgent elective surgeries were cancelled in March in preparation for a potential flood of COVID-19 patients. (Shutterstock / StockLeb)

Close to 200,000 surgeries and other medical procedures including cancer screening tests and clinical trials of experimental medicines were set aside indefinitely while hospitals in Canada reconfigured themselves in anticipation of a flood of COVID-19 patients, given the well-publicized effects of the novel coronavirus on European medical communities, swamping hospitals with the sick and the dying. Virtually overnight Canada's health-care system was retooled.

But the flood of COVID-19 patients failed to materialize. And those cases that did require medical treatment were relatively few and posed no treatment difficulties for hospital emergency rooms, with ample beds set aside in isolated areas. Dr. Krahn spoke of a colleague who checked on a patient awaiting a defibrilator implant, only to be informed that the patient had died after his surgery had been postponed.

For most people, given a diagnosis of heart dysfunction, cancer or other condition requiring close attention, anxiety weighs heavily. Having to wait longer for a tumour to be surgically removed, for clogged arteries to be seen to, or joint replacement to proceed, only increases the stress, at a time when the global pandemic threat itself preys on people's minds. About 20 to 40 percent of the usual volume of elective cancer surgeries took place during the COVID lockdown in Ontario.

Finally an announcement was made by Ontario and British Columbia of a return to normalcy, suspended operations to be resumed. Now the headache is the backlogs and how to cope with them. It might take up to two years to clear, notwithstanding the fact that there will be additional diagnoses and patients scheduled for surgery as well. The understanding that the longer the delays go on, the worse outcomes can be is of comfort to no one.

It was mid-March when hospitals began their transformation to COVID-19-concentration, freeing up ward room and intensive care units for COVID sufferers while cancelling non-emergency and non-urgent operations with the goal of having fewer patients recovering in ICUs, and being exposed to the in-hospital infection rate. Ontario performed 72,400 fewer surgeries as compared with the year before, while B.C. had 30,000 cancelled.

Yet, due to good luck or the effect of stay-at-home orders within the general population, Canadian COVID cases failed to meet the wave seen in places such as New York city. Hospitals in Ontario typically at close to 100 percent capacity, by mid-April were 59 percent full, with 11,200 free beds. Despite which health authorities claim non-coronavirus patients were not abandoned; triaging saw that those requiring urgent surgery received it within a reasonable time-frame.

Despite assurance aimed at breast cancer patients to advise them that their cancers at an earlier stage would not be deleteriously affected by a two-month surgery delay, patients remained unconvinced and under considerable stress. Particularly since, according to Eva Villalba of the Quebec Cancer Coalition, the risks related to delay were not explained to those awaiting treatment. MRIs, CT scans and similar diagnostic tests for cancer were also pared back, with the number of scans reduced by 25 percent in Ontario.

Screening tests such as mammograms, pap smears, colon-cancer tests, placed on hold as well. Chemotherapy and radiation treatment have proceeded in many provinces with "pauses" for some patients amid little evidence what effect that would have. In the interim, some patients awaiting surgery have been prescribed oral, take-home drugs like tamoxifen to fight the cancer, a regimen that would typically be started later in treatment.

Cardiac specialists have attempted to retain regular contact for heart patients to be aware whether symptoms such as fainting suddenly appear; in which case the delayed surgery would be moved forward. The growing concern among physicians relates to the pandemic side-effect of people unwilling to present at hospitals focusing on COVID when they experience symptoms of heart attack, preferring to wait until they would "feel better" during the coronavirus lockdown.

One cardiovascular society employee began feeling very unwell, but decided to delay seeking professional medical help. She possibly suffer3ed a heart attack, three days later, dying in her sleep, when heart failure set in. A 30 percent reduction in emergency room presentations was reported for Ontario, and for B.C. a 40 percent drop in people presenting to emergency departments with STEMIs, the most serious type of heart attack, according to the Heart and Stroke Foundation of Canada.