I volunteered in the HIV community for nearly 20 years after my diagnosis in 1994. It was a terrible time for many. Funerals were held every week, with people from diverse populations dying, often quite young. We needed a vaccine or at least treatments. For many, treatments did not come soon enough, and a vaccine is yet to be discovered.
In all those years, I never compared the situation of people living with HIV to people living with any other life-threatening illness. I was often asked if I felt people with HIV were treated poorly by governments compared to other diseases. My answer was, and still is, “Everyone who is sick should get what they need to stay alive and have a reasonable quality of life.”
I did not expect to be having those discussions again, in a time of an even more widespread global tragedy. COVID-19 has brought our health care systems, economies, and social networks to their knees. Our individual and collective mental health and physical well-being have suffered profoundly. We must all laud health care and allied service providers, who have done more than could ever have been expected to contain the spread of this scourge and to heal and comfort those directly impacted.
In the midst of COVID-19’s myriad of impacts, one stands out: in the systemic effort to combat this virus, other life-threatening illnesses have taken a back seat, including cancer. In September, at the European Society for Medical Oncology conference, a global study of 356 cancer centres reported that 88.2% of them had a significant, widespread adverse impact due to COVID-19. Even before the outbreak of COVID-19, cancer care services across Canada were near breaking point and, in some cases, were overwhelmed. Under those circumstances, how could the impact of this pandemic have been any different?
We must fix this situation now. If we don’t, the result may well be another public health crisis.
A dire prediction was made in June by the Director of the National Cancer Institute in the U.S. In an interview with ABC News, he warned that although cancer is being diagnosed less frequently during this period, the number of new cases remains the same. He explained that these cases would be diagnosed later and that late diagnosis would make them harder to treat and more likely fatal.
In Canada, it is predicted one out of two Canadians will be diagnosed with cancer during their lifetime. It is well known that the earlier a person is diagnosed and treated, the better their chances for survival and a reasonable quality of life. Stories have emerged over the last eight months from across the country of overcrowded emergency rooms, cancellations, delays in cancer screening, diagnosis, treatment and surgeries. Ontario surgeons are reporting a sharp rise in the number of people coming to hospitals with advanced cancers, an unintended consequence of the sudden shutdown of non-urgent health care services in the spring due to COVID-19.
In fact, the British Medical Journal reported in an October 2020 study that delaying cancer treatment by just a month can put patients at a sharply greater risk of dying, between 6% and 13% higher. The longer the wait for treatment, the higher the risk. Researchers estimated that a 12-week delay for breast cancer treatment would lead to 1,400 additional deaths in the U.K., and 700 in Canada, over the course of a year. In addition, the study suggests that the risk of premature death from delays of 10-12 weeks for colorectal cancer surgeries is increased by about 20%. A 4-week delay in surgery increased the risk of death by 6-8% for patients with bladder, breast, colon, rectum, lung, cervical and head-and-neck cancers.
To deal with the delays, alternative solutions are being employed wherever possible. For example, a process to get liquid biopsies from people at home to health care teams is helping move screening and early detection regimes forward. In British Columbia, a consortium has come together to enable crucial testing and treatments for people across Canada with cancer. Virtual care, also known as telemedicine or telehealth, has also become an important tool.
Oncology patient groups have banded together to pay for travel to appointments for patients in some large cities and provide pandemic-related information, including mental health support resources.
These interventions are temporary, but the problem of cancer care in Canada requires long-term solutions. We have cancer agencies in every province and a federal government-led Cancer Control Strategy.
We call on these healthcare leaders and decision makers to bring together cancer stakeholders, including patient representatives, to develop a sustainable, efficient, effective, and adaptable plan to ensure timely access to essential healthcare services for cancer patients and , in fact, for all patients who require them.
The last thing we want is to wake up from one public health nightmare with COVID-19 only to face another devastating public health crisis in cancer. We can still change course, but governments must act now, before it is too late, to ensure our healthcare systems are equipped to protect all Canadians in their fight against cancer.
Louise Binder is a lawyer and one of Canada’s leading health patient advocates. She cofounded the Canadian Treatment Action Council (CTAC) in 1996 which advocated for better access to HIV treatments and quality care. Louise is presently Health Policy Consultant for the Save Your Skin Foundation. Louise has received an Honorary Doctorate of Laws from her alma mater Queen’s Law School, the Order of Ontario and two Queen Elizabeth II medals.