A new survey released by the Canadian Cancer Society (CCS) suggests that one in four Canadian cancer patients have had their appointments postponed or cancelled in recent months.
In Nova Scotia, the number is even higher. As of November when the survey was conducted, 33% of Nova Scotian respondents indicated they’d had an appointment related to their cancer care either cancelled or postponed. For Atlantic Canada overall, the figure was 36%.
“When it comes to these results, what we’re hearing, what we’re seeing, is that while there are some improvements in some aspects of cancer care and supports since the peak of the pandemic, access to care remains inconsistent across the country and vital needs are not being met,” Heather Mulligan, CCS manager of advocacy for Atlantic Canada, said in an interview.
“It is a life threatening and life altering event and disease. And any time there’s a cancellation or postponement in their cancer care journey, it means that they’re on the journey longer…It’s life or death when we’re talking about cancer.”
Long term pandemic impacts on cancer care
The new survey is the sixth in a series of engagements CCS has had with patients and caregivers throughout the pandemic. The organization released the results on Saturday, Feb. 4 to coincide with World Cancer Day.
“We know that the COVID-19 pandemic not only has strained our health care system, has applied downward pressure on an already fragile system, but cancer care in particular has been facing unprecedented backlogs and it’s exposing some vulnerabilities, from delayed cancer surgeries and screenings to suspended clinical trials,” Mulligan said.
“But to me it’s also the long term impacts of the pandemic, and those are going to be felt by people with cancer, their caregivers, and our care system for years to come.”
The longer cancer remains undetected and untreated, the worse it is for patient outcomes. Mulligan said data based on the Canadian Cancer Registry suggests that pandemic-related cancer care disruptions, including screening and diagnostics, have led to delayed cancer diagnoses and also fewer diagnosed cases.
In 2020, there were 6.1% fewer new cancer cases identified compared to the annual averages in 2015 and in 2019.
“That’s indicating that there are a significant number of undetected cancer cases that will require treatment and care in the coming years, and this is going to add pressure to an already strained health care system,” Mulligan said.
“People who go undetected, when they finally do seek care or when they finally do get that diagnosis, it’s a later stage diagnosis requiring much more investment of time by the health system, ICU time, a variety of other resource draws from the health system.”
50% of NS caregivers concerned about emergency cancer care access
The survey also found that one in three patient respondents (33%) weren’t confident they’d receive timely and quality care in a cancer-related emergency.
In Nova Scotia, 50% of caregiver respondents reported the same lack of confidence when it came to accessing quality timely emergency cancer care for the person they were caring for.
“We have to consider the fact that there’s so much complication when it comes to cancer patients. Everyone should be able to access emergency care when they need it or where they need it. Full stop,” Mulligan said.
“Cancer patients, however, have very unique needs that can’t be met, for example, in a primary care setting…So there is some specialization of services required and currently those patients are accessing that care through emergency departments and through the emergency system.”
‘High volume users of our health system’
Mulligan said the survey was conducted in November, making it “fairly recent.” She said proper investments must be made to ensure that cancer care systems are as strong as possible.
“When we think about cancer patients, they are the high volume users of our health system. Everything from primary care to emergent care to surgeries and a variety of other aspects of care,” she said.
“So truly any investment in moving the needle when it comes to cancer care is a huge improvement of the health system overall.”
Another concern is that cancer diagnoses are on the rise. Mulligan points to the 2022 Canadian Cancer Statistics report on cancer prevalence published in November.
Produced by the Canadian Cancer Society, Statistics Canada, and the Public Health Agency of Canada (in collaboration with the provincial and territorial cancer registries), it only included data reported until the end of 2017. It didn’t account for any pandemic disruptions.
That November report noted:
International efforts suggest that the diagnoses of cancers were reduced by 40% between March 9 and May 17, 2020, compared to diagnoses averaged over the same time period in 2018 and 2019. In terms of screening, we know that the interruptions to programs will have a notable impact on future cancer survival.
These impacts will be picked up in subsequent versions of our analyses. Early reports from provincial analyses suggest that screening programs were paused and that biopsies, surgical referrals and even emergency department visits are down.
Furthermore, data from CIHI on the number of cancer surgeries shows a reduction in the first four months of the pandemic. Importantly, COVID-19 has impacted some populations more than others, exacerbating the inequities faced by many, including Indigenous people, racialized communities, LGBTQ2+ people and others.
17,000 new cases expected in Atlantic Canada
That report also found that as of 2017, 1.5 million Canadians were living with and beyond cancer, with Atlantic Canada leading in the per capita rate of diagnosis and survivorship.
“So while more people are living beyond cancer, more people are being diagnosed,” Mulligan said.
“We’re expecting 17,000 new cases in Atlantic Canada alone this past year. So those are what we know. That’s not what we don’t know.”
Mulligan said it’s important to recognize that health care workers are doing all they can to prioritize screening, diagnostics, and treatment to cancer patients.
But she said the lived experiences and voices of patients and caregivers are also critical and must be counted. She said that’s why the CCS launched its new Get Better card-writing campaign.
Details of the new initiative were highlighted on Saturday along with the release of the new survey. Through the online tool, patients and/or caregivers are encouraged to share their personal stories about accessing cancer care in Canada and how they believe it can be improved.
“We’re at a very interesting time in the conversation around what’s happening with our health systems, not only here in Nova Scotia, but across Canada. And the more people who get involved in helping shape what that looks like, the better,” Mulligan said.
Not just about surgeries and backlogs
Mulligan said personal stories have power because they bring a human element back into something that’s often very clinical. She hopes Atlantic Canadians participate by sharing with their elected officials how they think cancer care can be improved.
This spring, the CCS will print and deliver all submitted “get better” cards to members of Parliament, MLAs, and other decision makers.
“We’ve only been talking about treatments. That’s the downstream. (There’s) the work that we can do around prevention and the work that we can do around survivorship,” Mulligan said.
“When we talk about cancer it’s prevention, it’s screening, diagnostics, it’s treatment, it’s survivorship, it’s palliative and end of life, the affordability of care. There’s a whole journey there. It’s not just around surgeries and backlogs.”
‘Significant increase in cancer-related deaths’ expected
In September, the Canadian Cancer Society published a report titled ‘Living at the Crossroads of COVID-19 and Cancer’. That report found that there was a 20% reduction in cancer surgeries across the country during the first six months of the pandemic.
Researchers estimated “the devastating strain” the pandemic placed on the health care system will lead to “a significant increase in cancer-related deaths” over the next 10 years.
They estimated an additional 21,247 cancer-related deaths in Canada between 2020 and 2030.
Some models predict that a 10% increase in cancer diagnostic and treatment capacity would actually “mitigate a significant number” of the excess mortality.
The report suggested keeping cancer treatment capacity 10% lower than normal throughout 2021 will lead to 33,262 excess cancer deaths between 2020-2030.
But the researchers suggested increasing treatment capacity by 10% over normal beginning in June 2021 would, by comparison, lead to far fewer (4,210) excess cancer deaths between 2020-2030.
“Such an increased capacity would prevent approximately 80% of the estimated excess cancer mortality,” the report noted.
The Halifax Examiner reached out to Nova Scotia Health (NSH) for comment about the survey and its findings around postponed and cancelled cancer care appointments in recent months.
NSH hasn’t yet provided a response, but a spokesperson said on Friday they were working on it. This story will be updated if we receive a reply.
*Correction: The original headline on this story said “33% of Nova Scotian cancer patients.” That information was incorrect. We have updated the headline. We regret the error.