The Cost of Pausing Elective Surgery
When the Covid-19 pandemic hit the U.S. by force in March, elective surgery was paused while doctors and hospitals fought on the frontlines of the battle against coronavirus. While there were hopes that the coronavirus crisis could pass swiftly, six months later case numbers continue to rise, uncertainty abounds and life is still far from “normal”.
As a result, many patients are still either waiting for surgery that was postponed, more people have discovered they need surgery, and others are too afraid to enter a medical facility to have much-needed procedures carried out.
This bottleneck in the system has immediate ramifications for patients and society as a whole.
Small problems become much bigger…especially cancers
For some patients, the delay in surgery means what was a low-acuity procedure, such as cataract surgery or a joint replacement could have had a very real impact on their quality of life. “Many patients who had been waiting and preparing for their surgeries for weeks, if not months, now must suffer additional delays without ability to reschedule or plan for surgery.”
According to this article in the Harvard Business Review, this anticipated demand in combination with health providers’ decreased capacity will likely result in creation of wait lists and potentially worse patient outcomes and higher costs.
Given the reluctance of many to expose themselves to a hospital environment, these people are avoiding diagnostic tests and procedures, and not getting their cancers diagnosed. This further exacerbates the issue because the delay in diagnosis makes them less likely to be treated successfully when the cancers are eventually found, and makes for a potentially more expensive treatment plan.
At that point, the delay in surgery is quite literally a difference of life and death. For certain cancers, advancement to later stages can occur in as little as 4 to 8 weeks, well within projected delays of elective surgical procedures. Granted, outcomes for oncology patients are generally low, but delaying diagnosis and procedures makes the likelihood of a successful outcome even more unattainable.
“At many hospitals, so-called “elective” cancer treatments and surgeries have been deprioritized to preserve clinical capacity for COVID-19 patients. For example, some patients are receiving less intense chemotherapy and/or radiotherapy, and in other cases, patients’ operations to remove a newly detected tumor are being delayed. There can be no doubt that the COVID-19 pandemic is causing delayed diagnosis and suboptimal care for people with cancer.”
According to Benjamin Neel, director of the Perlmutter Cancer Center at NYU Langone Health, cancer deaths are going to far outnumber deaths from COVID-19. “You’d have to be crazy not to go see your doctor,” he told The Washington Post.
While COVID-19 has already caused over 195,000 deaths in the US so far (# as of publishing this article – although that number is, of course, still rising), cancer is an even larger issue. Over 600,000 people in the United States are expected to die of cancer this year, and almost 650,000 from heart disease. Certainly, many COVID-19 deaths could have been prevented with more caution, but cancer deaths can also be prevented with early detection.
Doctors are already seeing patients whose cancers have gotten much worse because of delays in care. “Instead of presenting with nausea and a five- to 10-pound weight loss, they are presenting with a 35-pound weight loss and a softball-size tumor in their head,” said Debra Patt, an oncologist and executive vice president of Texas Oncology.
The head of the National Cancer Institute has warned that Americans’ delays in screening, diagnosis and treatment because of the pandemic could lead to as many as 10,000 excess deaths from breast and colorectal cancer in the next decade.
Worsening the opioid crisis
There’s also the law of unintended consequences that could see the already severe U.S. opioid crisis skyrocket. If you’re missing the connection it’s because many patients who are awaiting elective surgery are prescribed opioids to manage their pain.
Given that many of them are waiting longer than usual for their surgery to take place, they run the risk of becoming addicted to the opioids being prescribed until they can have their operation.
“Even patients who’ve never used opioids before surgery have a 10% chance of becoming dependent. But patients who’ve been using opioids to manage pain before surgery have a 70% chance of remaining on opioids years later,” said a recent Fortune article.
“Before the virus hit, we had hardly even begun to grapple with the opioid crisis,” it continued. “And now, the coronavirus crisis risks sending millions more people down the road to medication dependency.”
But life goes on
Although it’s hard not to feel a sense of fatigue and frustration at the fact Coronavirus is still dictating everyday life for so many – and will likely do so for the foreseeable future – life goes on. At least for the time being, many restrictions have been lifted and people have returned to a semblance of “regular” life that is especially welcome after being curtailed for so long. Along with that comes the emergence of new injuries from sports and other activities, and more elective surgeries, which, unfortunately, may have a damaging effect on those patients waiting to get into the OR.