As Canadian doctors brace for the full surge of the COVID-19 tsunami, its ripples are already causing delays in cancer care.
The pandemic has created surreal experiences for everyone, including the 617 people in this country who are diagnosed with cancer each day on average, according to the Canadian Cancer Society.
"My biggest fear would be the collateral damage caused by the pandemic and the collateral damage is something like cancer care," said Dr. Jory Simpson, a surgeon at St. Michael's Hospital in Toronto who treats breast cancer.
Cara Heitmann, 53, of Toronto had her breast reconstruction cancelled and her mastectomy that was scheduled for next week is being postponed.
"I'm angry and I'm scared," said Heitmann, who lives alone and runs her own business. "I don't know if or when I will have surgery. I don't know if the cancer will spread. I don't know if it will mestasize. I don't know if I will survive this."
Heitmann said she has access to her surgeon's case notes that list her as a priority case. "I haven't been told what is now my prognosis."
Cancer care prioritized for patient safety
Simpson said that so far, if a patient has a deadly tumour needing emergency surgery, it will be removed. But as hospitals struggle to make space for COVID-19 patients, there's a new set of priorities including:
Ontario's health minister, Christine Elliott, said the decisions are made based on the evidence for each case.
"I know that is not a comfort to people with cancer that are having their surgeries postponed," Elliott told reporters on Thursday. "Those decisions are being made based in consultation with cancer-care experts."
Dr. Mary Gospodarowicz, a radiation oncologist and medical director of the Princess Margaret Cancer Centre in Toronto, said the hospital is focusing on preserving capacity to treat people with COVID-19 and keeping the hospital environment safe for patients and staff.
"Physicians would like to treat patients as quickly as possible and very promptly, but in these times of community transmission of COVID, decreasing the number of patients that come to the hospital and also interact with us is also safer for patients," Gospodarowicz said.
That's because people with cancer are more susceptible to COVID-19 infection and, in those with reduced immune systems because of chemotherapy or radiation, the course of the infection may be more severe, she said.
Chemotherapy treatment and follow-up is being delayed unless critical, and where possible, follow-up appointments are conducted online or by phone, she said.
"We're trying to call as many patients who had appointments as possible and then decide based on the phone call whether the patient needs to be seen in person or not," Gospodarowicz said.
Since clinic visits for follow-up and assessment are deferred, the number of patients coming to Princess Margaret has dropped from about 2,000 a day to 1,000 a day, with as many appointments as possible done by phone or virtually.
"The trickle-down effect of this is it causes a lot of anxiety," Simpson said. "Physicians and surgeons can provide reassurance right now that in some cases of cancer, waiting four weeks extra for surgery probably won't impact your ultimate prognosis."
Cancer specialists said, while the situation is fluid and unpredictable, they're doing their best to expedite cancer surgeries, while routine screening of healthy people has stopped.
WATCH | Mary Swark-Hougaard talks about her frustration at having to delay her breast cancer surgery because of COVID-19: