Drastic drop in cancer and heart attack patients linked to COVID-19

Doug Hendrie

14/04/2020 4:47:20 PM

Experts fear a sharp rise in delayed diagnosis and treatment due to coronavirus anxiety could overwhelm the hospital system once the pandemic is over.

Empty hospital corridor.
Some hospitals are short on patients due to coronavirus anxiety.

Coronavirus anxiety may lead to more deaths from cancer and heart attacks, with worrying declines of up to 50% in new cancer patients and 30% in cardiac emergencies, according to Victorian experts.
The pattern is part of a broader drop in patient attendances at hospitals and general practices across Australia, estimated at up to 50% across the board.
But delaying cancer treatment could lead to a spike in more dangerous tumours down the track, as well as an increased number of preventable deaths, with Melbourne ear nose and throat (ENT) surgeon Stephen Kleid predicting the sudden demand after the coronavirus crisis ends could overwhelm the system and lead to further delays in treatment.
Heart attack presentations have dropped by around 30% across both ambulances and emergency departments in Victoria over the past month, according to interventional cardiologist and medical advisor to Ambulance Victoria, Associate Professor Dion Stub.
‘It’s too soon to have hard numbers, but there’s a very real sense of a dramatic reduction in presentations to emergency departments and reductions in chest pain calls to triple zero,’ Associate Professor Stub told newsGP.
‘Most cardiology units around [the] country are considerably quieter than usual. There’s less elective surgery, but also less emergencies.’
The trend has been mirrored in Europe and the US, with American cardiologists reporting major drops in cardiac emergencies.
‘We’ve had so few deaths from COVID-19 that we may have more from preventable illnesses, from malignancies to heart disease,’ Associate Professor Stub said.
‘We’re the envy of the rest of the world in flattening the curve for the virus, but there are unintended consequences of that.
‘Europe and America are seeing well described, dramatic reductions in heart attack presentations.’
Associate Professor Stub fears that people are experiencing cardiac symptoms but staying at home.
‘They might not want to be a burden on the healthcare system, or they may have heard reports about people getting infected in hospital,’ he said.
That concern is backed by Associate Professor John Moloney, head of trauma anaesthesia at the Alfred Hospital in Melbourne.
‘We know there are patients already staying home with heart attacks because they don’t want to be a burden,’ he told The Age.
The situation is similar in cancer care, according to Mr Kleid.
He cites a small Taiwanese study undertaken during the 2003 SARS epidemic that found almost two thirds of lung cancer patients were afraid of visiting hospital during the outbreak, while more than a third felt SARS was more dangerous than their cancer.
Mr Kleid believes the same could happen in Australia after the coronavirus crisis ends.
‘There will be a backlog of delayed cancers,’ he told newsGP.
‘People are still going to the supermarket but they’re not going to the doctor. [Treating] a cancer is more important than the coronavirus for most people.
‘We’re not swamped like New York. People should still keep their doctors’ appointments.
‘We’ve got to get the word out to patients that if there are warning signs for cancer, go to the doctor. Otherwise we’ll be treating Stage 3 and 4 cancers instead of 1 and 2, which are harder to treat.
‘There will be panic once people say they’ve had this thing for three months, and then there will be longer delays because we can’t treat everyone in a hurry.’
The number of new patients coming to see Mr Kleid at the Peter MacCallum Cancer Centre in Melbourne has halved in the past few weeks, with many other specialists at the centre in the same boat.
‘I’d expect it would be 30–50% across the board,’ he said. ‘Women aren’t going in for breast screenings, men aren’t going for prostate biopsies.’
Mr Kleid said patients are likely to be anxious about the possibility of contracting coronavirus in hospital, but he is aware of blocks becoming apparent at every stage of the process.
‘Patients are delaying checks for their symptoms, GPs may be reluctant to see patients or send them for scans, or patients may be reluctant to see GPs,’ he said. ‘There’s reluctance to refer patients to specialists and reluctance by patients to book appointments.
‘Some patients may be scared to come to hospital.’
Issues are also emerging with access to vital radiology scans due to departments reducing staff days, Mr Kleid said.

A spokesperson for the Peter MacCallum told newsGP the cancer centre is ‘actively contacting GPs and specialists’ to let them know patients should still be referred for treatment.

‘Surgery, radiation therapy, haematological therapies, chemotherapy, hormone therapy, immunotherapy, including CAR-T cell therapy, are all available for our patients,’ he said.

‘We’d urge people to see their doctor if they have health concerns, because delaying treatment can potentially affect outcomes.’

Pathology tests around Australia have dropped by 40% in recent weeks, indicating another fall in demand. 
The concerning trend has led Australia’s Chief Medical Officer Professor Brendan Murphy to encourage patients to get treatment.
‘You can go and see a doctor. Please don’t neglect general medical health conditions,’ he said.
While non-urgent elective surgeries have been cancelled, leaving home to access necessary healthcare is still permitted across Australia.

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Dr Raymond Yeow   17/04/2020 12:47:14 AM

"......We’ve had so few deaths from COVID-19 that we may have more from preventable illnesses, from malignancies to heart disease,’ Associate Professor Stub said...."
Umm....maybe somebody should have thought of this before major decisions were made …..