Cancer patients face treatment delays and uncertainty as coronavirus cripples hospitals

Cancer patients face treatment delays and uncertainty as coronavirus cripples hospitals

Reviewed by James Ives, M.Psych. (Editor) Apr 7 2020 The federal government has encouraged health centers to delay nonessential surgeries while weighing the severity of patients' conditions and the availability of personal protective equipment, beds and staffing at hospitals. People with cancer are among those at high risk of complications if infected with the new coronavirus. It’s estimated 1.8 million people will be diagnosed with cancer in the U.S. this year. More than 600,000 people are receiving chemotherapy. That means millions of Americans may be navigating unforeseen challenges to getting care. Christine Rayburn in Olympia, Washington, was diagnosed with breast cancer in mid-February. The new coronavirus was in the news, but the 48-year-old did not imagine the outbreak would affect her. Her doctor said Rayburn needed to start treatment immediately. The cancer had already spread to her lymph nodes. “The cancer tumor seemed to have attached itself to a nerve,” said Rayburn, who was a schoolteacher for many years. “I feel pain from it on a regular basis." After getting her diagnosis and the treatment plan from her medical team, Rayburn was focused on getting surgery as fast as possible. Meanwhile, the coronavirus outbreak was getting worse, and Seattle, just an hour north of where Rayburn lives, had become a national focal point. Rayburn’s husband, David Forsberg, began to get a little nervous about whether his wife’s procedure would go forward as planned. “It did cross my mind,” he said. “But I did not want to bother with that possibility on top of everything else.” Two days before Rayburn’s lumpectomy to remove the tumor, Forsberg said, the surgeon phoned, “pretty livid” with bad news. “She said, ‘Look, they’ve canceled it indefinitely,'” Forsberg remembered. The procedure had been scheduled at Providence St. Peter Hospital in Olympia, a facility run by Providence Health & Services. Across Washington, hospitals were calling off elective surgeries, in order to conserve the limited supply of personal protective equipment, or PPE, and to prevent patients and staffers from unnecessary exposure to the new coronavirus. “It just felt like one of those really bad movies, and I was being sacrificed,” Rayburn said. “It was like we just got cut off from the experts we were relying on,” her husband said. The hospital said it would review the decision in a few weeks. But Rayburn’s surgeon said that was too long to wait, and they needed to move to Plan B, which was to begin chemotherapy. Originally, chemotherapy was supposed to happen after Rayburn’s tumor surgery. And rearranging the treatment plan wasn’t ideal because chemotherapy isn’t shown to significantly shrink tumors in Rayburn’s type of breast cancer. Still, chemotherapy could help stop the cancer from spreading further. But as the couple figured out the new treatment plan, they ran into more obstacles. “She needed an echocardiogram, except they had canceled all echocardiograms,” said Forsberg. They spent days on the phone trying to get all the pieces in place so she could start chemotherapy. Rayburn also started writing to her local lawmakers about her predicament. Hospitals prioritize urgent cases In mid-March, Washington Gov. Jay Inslee banned most elective procedures, but he did carve out exceptions for certain urgent, life-threatening situations. “It actually said that it [the ban] excluded removing cancerous tumors,” Rayburn said. Providence hospitals use algorithms and a team of physicians to figure out which surgeries can be delayed, said Elaine Couture , chief executive of Providence Health in the Washington-Montana region. “There are no perfect decisions at all in any of this,” said Couture. “None.” Couture would not talk about specific patients but said she assumes other cases were more urgent than Rayburn’s. Related Stories



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