Doctor slams Covid cancer plan ‘disgrace’
A retired oncologist says hundreds will die from cancer found too late due to the nation-wide shutdown, and catchup process could take years. Florence Kerr reports.
THE 22 Covid-19 deaths will pale in comparison to the wave of deaths from cancer that will hit New Zealand, a respected oncologist predicts.
Recently retired oncologist Dr David Lamb, who worked in the cancer sector for more than 40 years, was the head of radiation oncology at Wellington Cancer Centre, and currently holds an academic position at Victoria University, has called the Ministry of Health’s handling of cancer diagnostics during lockdown a ‘‘disgrace’’. He says the move has signed the death warrant for hundreds of Kiwis.
And despite the Ministry of Health pouring millions of dollars into the health sector to catch up on cancer diagnostics missed during lockdown, Lamb says it’s too little, too late.
In May, a report by the newly formed Cancer Control Agency found there were 1031 fewer cancer registrations in April
2020 compared to April 2019, a 47 per cent decrease, due to nonurgent diagnostic services being deferred during lockdown.
The figure is in line with what other countries experienced during lockdowns designed to contain the coronavirus pandemic. The report has prompted swift action from district health boards (DHBs) to catch up on diagnostics.
But Lamb said the catch up would only have worked if New Zealand was on top of diagnostics prior to the virus hitting New Zealand.
‘‘The 22 deaths from Covid is going to appear tiny compared to the excess deaths from cancer as a result of lockdown,’’ he said.
‘‘This is as a result of lockdown not permitting cancer diagnostic services to continue their essential work. It should have been ramped up like the supermarkets.’’
Lamb said the already stretched waiting lists for diagnostics would be further impeded by the thousands missed during the lockdown.
‘‘That is complete garbage,’’’ Lamb said.
‘‘This concept that we should catch up on just the April cases in three months is really quite ridiculous.
‘‘Let’s say in June the cancer diagnostic services are back to normal. We’ve got all the cases that would have come in during June, which is about roughly 2000 new cases each month, and we’ve got this thousand from April that we didn’t diagnose.
‘‘It’s bound to take a long time to clear that backlog of cases and a lot more cancer patients are going to die as a result of that.
‘‘What I’m saying is that my modelling says there are going to be wait times for cancer diagnosis that are going to be around for a number of years rather than months.
‘‘And therefore, the number of deaths is going to be in the hundreds, not in the 10s. Or just a few.’’
Cancer Society Medical Director and oncologist Dr Chris Jackson said studies from the United Kingdom, suggested New Zealand had a three-month window to capture the 1031 people who were not diagnosed during lockdown or risk the deaths of 400 people.
The Cancer Control Agency was established in December 2019.
The agency’s chief executive Diana Sarfati said there was no modelling on the impact of delayed diagnosis but some work internationally was progressing.
Despite the figures in her May report showing a 47 per cent decrease in cancer diagnostics during the lockdown, Sarfati said time-sensitive diagnostic services had continued.
Sarfati said Lamb’s estimates were likely based on UK studies, which focused on the possible impact on cancer patients if treatment services were shut down for three months.
She said recent figures showed there had been a seven per cent decrease in new cancer registrations and an 8.6 per cent decrease in breast cancer diagnosis to date.
Her report had found that cancer treatment services ‘‘were well-maintained during the lockdown period,’’ she said.
Asked about diagnostic waiting lists prior to Covid-19, Sarfati said testing for cancer includes a wide variety of tests depending on the clinical context.
Sarfati would not provide
figures on pre-Covid wait times for testing for the top three fatal cancers in New Zealand: lung, colorectal and breast cancer. Instead, she said there were many ways to test for cancer, including biopsy, radiology, scans, blood tests, mammography, and colonoscopy. ‘‘Depending on what symptoms people have, their doctor will organise the relevant tests. For more complex tests, patients are prioritised to ensure the most urgent tests are done first.’’
To the best of her knowledge there were no major systemic delays for breast cancer prior to the virus.
However, Evangelia Henderson, chief executive of Breast Cancer Foundation NZ, said the lockdown had caused unacceptable delays to breast cancer diagnoses with more than 400 cases going undetected.
The Government had recognised there were delays and committed to developing an early access programme in its Cancer Action Plan, Henderson said.
‘‘The situation with Covid-19 has clearly caused great disruption, but this can’t be an excuse to push this important commitment to the back of the queue.
‘‘More than 650 women in New Zealand die due to breast cancer annually and funding an early access programme would result in fewer deaths, so we need to see action on this now,’’ Henderson said.
Lamb said there were long wait lists for diagnostics in other areas as well prior to Covid-19. Lamb himself said he had recently had a colonoscopy for which he had to wait four months on the public waiting list. The wait time under private health insurance was two to three months.
‘‘So, you know, a lot of the arguments that are going around about more money will fix it is absolute nonsense,’’ he said.
‘‘When you look at colorectal cancer the private system doesn’t have any slack. The public hospital is underresourced. You need skilled individuals and it takes years to train these people up. So a lot of money poured in the top of the system is going to make absolutely no difference to how long you wait for your cancer diagnosis because you need extra people who are in short supply and believe you me I have sat on a number of committees that told the ministry this on multiple occasions.’’
Lamb said he had little faith in the newly-established Cancer Control Agency.
‘‘They’re making the statement that cancer diagnosis was allowed to continue during lockdown and it was patently obvious it wasn’t because we missed a thousand cases that we would normally have diagnosed.
‘‘Having an X-ray or a scan or a mammogram is just separating out those patients who are more likely to have cancer from those who probably don’t.
‘‘You can only diagnose by getting a little bit of tissue for the pathologist to look at under the microscope ... That’s the only way you can actually make a diagnosis of cancer is by looking at the tissue under the microscope and that didn’t happen.’’
But Jackson said the Cancer Control Agency was exactly what the country’s cancer sector needed.
The reporting by the agency and its strong commitment to closing the gap was already being seen, he said.
‘That is complete garbage. This concept that we should catch up on just the April cases in three months is really quite ridiculous.’ DR DAVID LAMB