In absolute silence, barely interrupted by the intermittent sound of a remote monitor and the whisper of a nurse, Dr. Antoni de Lacy holds his breath in his operating room. On a stretcher a patient with a rectal tumor. Surgical intervention is forthcoming to remove it. But no. Lacy, an experienced surgeon at the Clínic de Barcelona, does not see this clearly. The patient has five laparoscopic arms inserted into the abdomen, one with an integrated camera and the other four with surgical fittings that allow for less invasive surgery. Lacy looks at the screens in the operating room that show a picture of the gut in real time and frowns. Move that kind joysticks he easily picks up some tissue here, cauterizes there, pushes away the yellowish buildup of fat, and stops again. “This tumor is very large,” he snorted. The intervention is feasible from a technical point of view, but the malignant mass is too large and, if complete resection is to be achieved so that there are no cells that can reproduce the tumor, they must first be given chemotherapy. The intervention stops. Lacy, between anger and astonishment, laments, “These are collateral damage to COVID. A patient with a one-year clinical picture [sangre en heces] to whom no tumor has been previously detected. Now we see patients who are diagnosed later ”.
This patient is not the only one, neither the first nor the last, Lacy assumes. “Covid was a disaster. The diagnosis is made later. We don’t have patients in the early stages of the disease. The cases that have come to us lately for surgery have advanced tumors,” he complains. coronavirus and primary care buried in mild cases, and by monitoring positives and contacts, made it difficult to access the health care system.Consultations are delayed and diagnosis is delayed.
The European Cancer Organization estimates that about a million cancer cases remain undiagnosed, and in addition, 100 million early detection tests, such as stool blood or mammograms, were stopped during the crisis, leading to later diagnoses and reduced overall survival. “30% of cancer patients we operated on were diagnosed probira [las pruebas rutinarias]: You operated on them and 90% were cured by surgery. However, we no longer have these patients. But the disease exists. It’s still there, ”adds Lacy.
Following an analysis that collects studies, reports and interviews with the cancer industry, the European Cancer Organization estimates that European doctors saw 1.5 million fewer cancer patients and treatment delays in the first year of the pandemic across Europe. in two cancer patients – now estimated to affect one in five.
Rafael López, head of oncology at de Santiago Hospital and president of the Foundation for Excellence and Quality in Oncology (ECO), warns that “collateral damage from covid will be more important than the pandemic itself”: “The disaster is very large. cancer increased by 30%. The hardest part was late last year, when you saw real monsters, the tumors were so advanced that you couldn’t do anything. It’s reduced now, but we will continue to see advanced tumors, they will appear in the coming months or years. ” .
The effects of cessation of health care are not fully measurable, but the first figures of the effect are beginning to emerge. According to a study by several Spanish scientific societies, during the first wave of new diagnoses fell by 21%, and tests to detect possible tumors, such as cytology, fell by up to 30%. Research in England also indicates a reduction in patient involvement in the oncology circle, especially during the first plague of a pandemic, which can cause a significant excess of cancer deaths in one year. A study in France also reported delays in the treatment of newly diagnosed patients, particularly in breast and prostate tumors and in non-metastatic neoplasms.
López warns that the rise of the fifth wave maintains delays and all the collateral damage that underlies delays in diagnosing and caring for the disease that is a slave to time: the later it is resolved, the worse the prognosis. “This new wave means more delays in diagnosis and society will condemn us for it. We failed to adjust. It is understandable that the first wave caught us in place, but it is not acceptable to be in the fifth wave without a structure that maintains the rest of the pathologies, ”López laments.
The president of the EKO foundation also warns that some patients are still afraid to go to the hospital. This is not the terror of a first-wave infection, but reluctance still exists. Salvador Morales, president of the Spanish Association of Surgeons, points out that these fears, together with the lack of early detection tests and difficulties in accessing “overburdened” primary care, prompted delays in care: “The patient told me in prison to the hospital for fear of the virus. You have to tell people that they are not afraid and that they have to find a way to access the system. Diagnostic tests must continue and support primary health care. ” Enriqueta Felip, vice president of the Spanish Society of Medical Oncology (SEOM), agrees with this message: “Primary care has collapsed, but the preferential circle for suspected cancer still exists. If a person has symptoms, he must be consulted.
Since entering the health care system, primary care warns that collateral damage from covids goes beyond cancer. Salvador Tranche, president of the Spanish Society for Family and Social Medicine, insists the consultation comes with “highly developed conditions that will lead to higher mortality.” And it cites three major collateral effects that the pandemic has brought: a reduction in preventive activities, such as cancer screening, that delay diagnosis and treatment; impact on time-dependent diseases, “with highly developed heart attacks and appendicitis or tumors without the possibility of surgical access”; and, third, decompensation of chronic patients. “We found clinical pictures we hadn’t seen in years, with deteriorating levels of control of pathologies like diabetes or respiratory failure. In addition, all mental pathology is decompensated and there are numerous delays for diagnostic tests. I look to the future with great concern because we are tired and we lack human resources, ”says Tranche.
The system has learned to combine COVID with rapid care for acute and emergency pathologies, but is suspending care for chronic patients, argues Ángel Cequier, president of the Spanish Society of Cardiology. Patients with heart failure, “who need very fine adjustment, are more easily destabilized,” he notes, and control of diabetes and hypertension, which requires frequent check-ups and visits, is lost in many patients. “The problem is to see how we will recover the quality and follow-up of cardiovascular patients. Covid can also destabilize these diseases and cause increased mortality. We will pay for the impact of the loss of health care continuity, ”adds Cequier. The cardiologist warns that barriers to accessing primary care, “who is the one who identifies and gives the alarm for cardiovascular disease,” will limit the diagnosis; and reduction of tests, such as catheterization, will affect the therapeutic approach.
One of the great paradoxes that the pandemic has abandoned, claims Albert Goday, head of the endocrinology department at Barcelona’s Mar Mar Hospital, is that “diabetes and obesity are the most unfavorable clinical course factors in combating COVID,” but these and other diseases are “suppressed” within the health system. Even though he was determined to deal with the coronavirus infection. Given the flood of cases in the fifth wave in Catalonia, hospitals had to suspend surgical activities again, and in his hospital, Goday points out, “the first program that was suspended was bariatric surgery,” a procedure to treat obesity when a patient does not respond to treatment . “A person who has been waiting for this intervention for two years, who does sprint In the end, in order to try to lose weight and get to the surgery as well as possible, you have to call him and tell him that he will not go for surgery. This is very difficult. He has put in a lot of personal effort to change his habits and has to keep waiting. It’s terrible, “laments the endocrinologist. Delays in interventions and tests are thought to lead to weight gain in obese patients, discontinuation of treatment, and worsening of their clinical situation. “We’ll come later to treat them.”
The worst was the first wave, consult experts agree. But from those muds, these muds. The pandemic did not stop and the system did not recover. The delay adds up and continues. “The intervals without waves are so short that we did not return. Continuity of care is severely disrupted, ”warns Cequier.