Testing key to return of full cancer services
A LEADING cancer doctor has said testing of patients and healthcare workers will be key to returning to normal cancer treatments for patients.
Professor Peter O’Gorman said every surgical patient should be routinely tested for Covid-19 before being admitted to hospital.
“I think we are moving into the phase of asymptomatic testing. I think every surgical patient, whether day case or general anaesthetic, coming into the hospital will have to be shown to be Covid-negative within 24 to 48 hours before admission,” he said.
“I also believe that health work, particularly frontline health workers, dealing with vulnerable cohorts in hospitals and nursing homes, will also require regular testing, in my view.”
Prof O’Gorman, director of pathology and consultant haematologist at the Mater Misericordiae hospital in Dublin, added that, while restrictions will slowly ease from tomorrow, the return of normal services for immunosuppressed or vulnerable groups will take longer.
“We need to be behind that,” he said.
Covid-19 has resulted in some cancer treatments being deferred because of the high risk of infection to vulnerable patients, while others have been modified.
With no sign of a vaccine and the recurring threat of infection, one of the main challenges for doctors is how to perform invasive surgeries in a safe way, for vulnerable patients and for healthcare teams.
The Irish Cancer Society has called for an action plan to restore cancer services to pre-pandemic levels and to clear the expected backlogs caused by the suspension of cancer screening services. Chief executive Averil Power said delayed cancer diagnoses will lead to a “second wave of Covid-19 related deaths in Ireland”.
A study by the University of Birmingham estimates the Irish backlog to be 16,000, which includes cancer operations. However, the true scale of the backlog is unlikely to be known for another two months, according to oncologists.
Cancer treatments that have been put on hold in Ireland include bone marrow transplantation and stem cell transplantation, used for leukemia, multiple myeloma or some types of lymphoma.
“We have a number of patients that were scheduled for those procedures and internationally really, it was agreed that it was not appropriate to proceed with those very intensive and immunosuppressive therapies, because of their risks,” said Prof O’Gorman, adding that the situation is not “ideal”.
“We’re hoping that that restriction will be lifted in the not too distant future, so we do have some catching up to do there.”
However doctors say cancer treatments have not stopped. Dr Richard Bambury, medical director of oncology services at Cork University Hospital, said more than 200 patients began courses of radiotherapy in private hospitals in the region, during the six-week period when the
Covid-19 restrictions were at their height. Fifty patients began chemotherapy.
“Where people needed chemotherapy and radiotherapy, and we felt it wasn’t safe to defer, we went ahead,” said Dr Bambury.
Some patients ordinarily considered for chemotherapy once a cancer has been removed, such as people with lung or colon cancers, are being managed through surveillance and scanning instead. “This would be especially in patients who might be developing a higher risk of having problems from Covid-19 if they got it,” Dr Bambury said.
Cork University Hospital is to resume endoscopies, colonoscopies and other internal examinations this month. Patients are already screened for Covid in hospitals by gauging temperature and other potential symptoms. However, Dr Bambury said there may have to be widespread screening of patients for the virus, including testing for it. In certain cases, such as lung cancers, CT scans may be performed before surgery to look for evidence of infection that could indicate Covid-19. However, the caveat is that Covid-19 can go undetected by tests and sometimes no symptoms will show.
“We are not going back to what we did before. We are using a more socially distanced method of working and will have to take it week by week to see how the processes work,” said Dr Bambury.
“What we need to do now that we have come through the initial phase relatively successfully, is to consider how we can ramp up activity to as close to pre-Covid levels as possible.”
The Irish Cancer Society’s Support Line can be contacted on Freephone 1800200700 seven days a week.
‘We’re hoping that restriction will be lifted in the not too distant future’