More Canadians could face advanced cancer linked to diagnostic delays during the COVID pandemic

It all started with a stomach bug.

At least that’s what Cheryl-Anne Labrador-Summers thought. It was October 2020, shortly after moving to the quiet lakeside community of Georgina, Ontario, and instead of relaxing with her family as she had planned, the mother of three was struggling to understand why she kept having strange and unexplained experiences. stomach cramps.

Labrador-Summers attempted to visit her family doctor, but the office was closed due to the COVID-19 pandemic. So she looked for another clinic – only to be offered a phone appointment rather than an in-person assessment. She ended up being told that her fussy digestive system was probably caused by a mild gastrointestinal illness.

In January, the 58-year-old had a distended stomach, looking – in her own words – “about nine months pregnant”. Again, she contacted a doctor, went for tests, and then headed to the nearest emergency department.

After finally seeing a doctor in person for the first time in months, she learned the real cause of her discomfort: bowel obstruction caused by cancer.

“It ended up being a nine-centimeter tumor, and it completely blocked my lower intestine,” she said.

Emergency surgery left Labrador-Summers with 55 staples down his torso and months to recover before he could start oral chemotherapy. His question is now unanswered but painful to consider: Could this ordeal have been avoided, or at least minimized, by an earlier diagnosis?

“If I could have seen the doctors sooner, I wouldn’t be at stage 3,” she said. “I might have been a Stage 2.”

Photos show Labrador-Summers with a distended stomach before his emergency surgery, left, and the 55 staples along his torso after the procedure. (Provided by Cheryl-Anne Labrador-Summers)

951,000 fewer cancer screenings in Ontario

More Canadians could be diagnosed with late-stage cancer in the coming years, medical experts warn, predicting a looming crisis related to the ongoing COVID-19 pandemic.

“We expect to see more advanced stages of presentation over the next two years, as well as impacts on cancer treatments,” said oncologist Dr. Timothy Hanna, clinician scientist at the Cancer Research Institute. Cancer from Queen’s University in Kingston, Ontario.

“We know that time is running out for people with cancer. And when people are waiting for diagnosis or treatment, it has been associated with increased risks of advanced stage and poorer survival.”

A review of Ontario’s breast, lung, colon and cervical cancer screening programs showed that in 2020 there were 41%, or more than 951,000, screening tests less than the previous year.

Testing volumes rebounded after May 2020, but were still 20% lower than pre-pandemic levels.

WATCH | Advanced-stage cancer diagnosed in Canadian emergency rooms:

ERs facing late-stage cancer diagnoses amid pandemic

Hospital emergency rooms are seeing a surge of patients diagnosed with late-stage cancer after the COVID-19 pandemic forced many doctor’s offices to close or switch to virtual appointments, which has led to fewer cancer screenings.

This drop in screenings translates to fewer invasive cancer diagnoses, including about 1,400 to 1,500 fewer breast cancers, wrote Dr. Anna N. Wilkinson, assistant professor in the Department of Family Medicine at the University of Ottawa. , in a May comment for the journal Canadian Family Physician.

“The impact of COVID-19 on cancer is significant: screening backloglate examination of symptomatic patients and abnormal screening results, and delays in cancer treatment and research, all exacerbated by the patient’s apprehension of being seen in person,” she wrote.

“It is clear that there is not only a lost cohort of screened patients, but also a subset of missed cancer diagnoses due to delays in patient presentation and assessment,” leading to what these cancers are diagnosed at a more advanced stage.

Difficult to access “timely” care

The slowdown in colonoscopies could already lead to more serious cases of colorectal cancer in Ontario, for example, offer a paper published in the Journal of the Canadian Association of Gastroenterology.

“Patients who were treated after the onset of the COVID-19 pandemic were much more likely to present to hospital urgently. This means they were more likely to have bowel perforation or severe bowel obstruction, requiring immediate life-saving surgery,” said study lead author Dr. Catherine Forse on a call with CBC News.

“Additionally, we found that patients were more likely to have large tumors.”

Scarborough Health Network emergency physician Dr. Lisa Salamon is pictured outside Birchmount Hospital in Scarborough, Ont. (Evan Mitsui/CBC)

In some cases, such as in the case of Labrador-Summers, Canadians learned alarming news about their health in hospital emergency departments after struggling to receive hospital care by other means.

Family doctors’ offices closed, the shift to telemedicine and some patients’ fears about COVID-19 may all have played a role.

“It has become more difficult for patients to access care and to access it in a timely manner,” Hanna said.

“At the same time, there were real risks – and there are real risks to leaving home to go anywhere, including going to an outpatient clinic or hospital to get checked out.”

Dr Lisa Salamon, an emergency physician with the Scarborough Health Network in Toronto, said she is now diagnosing more patients with serious cancers, including several in the past few months alone.

“So before it might have been localized or something small, but now we actually see metastatic cancer that we are diagnosing,” she explained.

Lessons for future pandemics

Health policy expert Laura Greer is herself battling stage four, metastatic breast cancer after waiting more than five months for a routine mammogram she was originally scheduled to undergo in the spring of 2021 – a measure of precaution given that his mother also had breast cancer.

Unlike an early-stage diagnosis, Greer’s cancer is only treatable, not curable.

“It was an example of what happens when you don’t have the regular screening or those wellness visits,” said the Toronto resident and mother of two.

“I probably would have had cancer at an earlier stage if it had been earlier.”

Health policy expert Laura Greer is battling stage 4, metastatic breast cancer after waiting more than five months for a routine mammogram she was due to have in the spring of 2021. (Esteban Cuevas/CBC News)

Suspending access to care and screenings for other health conditions can have disastrous effects on patients, Greer says, offering lessons for how policymakers tackle future pandemics.

“We need to make sure we have enough capacity in our health care system to be able to adapt, and that’s what we really didn’t have for that,” she said.

For Labrador-Summers, it’s hard to forget the moment her life changed as she was alone in an emergency department, learning of a terrifying diagnosis from a doctor she had just met. Her mind raced with questions about the future and worries for her family.

Labrador-Summers’ husband and one of his sons hug her on the dock near their lakeside home in Georgina, Ontario. (Osama Farag/CBC News)

“My eldest son had just told us he was expecting a child, and I just wanted to be there for them. And I didn’t know what the next steps were. And we lost my mother to cancer a while ago. few years – for us, the cancer was still terminal,” she recalls.

“So again, I’m on my own, trying to process all of this.”

A screening after Labrador-Summers’ surgery and chemotherapy treatment revealed more cancer.

“It’s deadly now,” she said.