August 31, 2020

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The COVID-19 pandemic has caused disruptions in the delivery of medical care across specialties.

Although the challenge of continuing care has been met with innovative solutions, such as telemedicine, some screenings and treatments — including many for cancer — cannot be provided remotely.

“There is no debate or question that cancer needs to be treated and a delay could lead to a bad outcome,” Barry Sleckman, MD, PhD, director of O’Neal Comprehensive Cancer Center at The University of Alabama at Birmingham, said in an interview with Healio. “If you have cancer, even if you’re in a region of the country where the coronavirus infection rate is pretty high, you should work with your doctor to do everything possible to get treatment.”

National trends have shown a dramatic decrease in cancer screenings and clinical trial participation since the start of the pandemic. The reduction in routine screenings could lead to 10,000 or more excess deaths from breast and colorectal cancers within the next decade, NCI Director Norman E. “Ned” Sharpless, MD, wrote in an editorial published in June in Science.

Sleckman and his colleague, Monica Baskin, PhD, professor in the division of preventive medicine at The University of Alabama at Birmingham and associate director for the cancer center’s Office for Outreach and Engagement, led a discussion on Zoom about the problem of delayed screenings and treatments during the pandemic. Sleckman discussed these issues in an interview with Healio.

Question: What delays in care are most dangerous?

Answer: The most harmful is a delay in treatment. For screening, we encourage people to talk to their physicians. There are some people for whom screening is a lot more important than others. For example, a woman with a significant family history of breast cancer should do everything possible to receive breast screening at the regular time rather than delay it. Meanwhile, someone who is young and has no family history of breast cancer could potentially wait a few months, if necessary, to undergo screening. I say if necessary because the safety issues surrounding screening are very different depending on the region of the country you are in. Even within Alabama, for example, the situation could be very different from one hospital to another. This is why it’s important to work with your physician, who will know your risk for cancer and therefore the importance of screening.

Q: Can patients feel safe with this riskvs.benefit approach?

A: We as a country, and as a health care system, are facing the reality that we’re going to have to settle in with the COVID problem for a while. So, unlike 4 months ago, when we closed all the mammography units, we now have things in place that mitigate a lot of the risk in these screening facilities. We make sure there are not a lot of scheduled appointments, so that patients aren’t collecting in the waiting room. We limit person-to-person contact. We clean the facilities incredibly well. There is always risk, but we do everything possible to mitigate that risk.

Q: Are there any situations where deferring treatment would be acceptable or preferable?

A: There are certainly cases of slow-growing tumors that usually have a good prognosis where you could say, “OK, maybe I’ll wait another month,” but then I would then ask, “What are you waiting for?” The health care system has done everything possible to limit the risk to patients who are not infected, even though there are patients in the hospital who are infected. Frankly, most hospitals in regions where the virus is now peaking are going to close their screening centers anyway. It doesn’t make sense to run a screening center while your hospital is filling up with sick people.

Q: How should an oncologist discuss this situation with a patient who might be hesitant or afraid, particularly in these peak areas?

A: I think you balance the fear with the potential benefit. If the patient says, “I’m not doing that,” you have your answer. However, if they patient says, “What is the potential risk to delaying vs. the benefit?” you can have a discussion. Our institution is letting people know we have instituted practices that we think will limit the possibility of patients visiting our facility being infected. We are also reaching out to the community through many mechanisms, including with the state department of public health, and spreading the message that patients should talk to their physicians about screening.

Reference:

For more information:

Barry Sleckman, MD, PhD, can be reached at 1824 6th Ave. South, Birmingham, AL 35233; email: bps@uab.edu.




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