In any other year, a 90-year-old cancer patient would have done a consultation with a specialist alone—no visitors allowed in the exam room. But 2020 was not a normal year—and 2021 won’t be, either. Because of the pandemic, the same woman could sit in her home on a telemedicine call, her grown daughters in the room with her. That way, all of them could make a good, informed decision together.
This case is an example of something positive coming from challenging circumstances, according to Dr. Douglas Yee, professor of medicine and pharmacology at the University of Minnesota’s Medical School and director of the Masonic Cancer Center. On the other hand, he sees a new threat: COVID-19 causing patients to fall behind on cancer screenings or treatments.
And Dr. Yee’s not the only one. In June, when Americans were several months into the coronavirus pandemic, an op-ed in the journal Science opened a lot of eyes. Penned by National Cancer Institute director Norman E. Sharpless, it detailed a model in which “moderate disruptions in care” for cancer screening and treatment could lead to 10,000 excess deaths from breast and colorectal cancer alone over the next decade. Add the dozens of additional types of cancer and related syndromes, and the numbers explode.
Screenings opened back up last summer. “We’ve gone a long way to implement all of the CDC recommendations in social distancing, disinfection, and equipment,” Yee says. “Everyone from radiology technicians to staff are clued in.”
Yee adds that while surgeries, including those for breast cancers, were delayed during the first peak of COVID in Minnesota, hospital functions have largely resumed. Yee acknowledges, though, the challenge of addressing people’s fears of being exposed to COVID. “People are leery of coming to the hospital,” Yee says, noting he’s not aware of any patient-to-patient viral transmissions at his hospital. “And we really don’t want to delay people being seen because of that. I’d argue that the hospital systems are doing the most in preventing exposures. We’re on the front line, and we know what this disease is.”
Patients have also missed scheduled appointments and even ignored symptoms to avoid burdening already strained medical system resources. “People can think screening is elective, for example, but the consequences of saying, ‘I don’t need this now’ will lead to long-term complications once the pandemic is over,” Yee adds. “The data show that patients who participate in these screenings have lower death rates from those cancers, such as breast cancer.”
Vaccine rollouts, potentially signaling the end of the pandemic, offer meager consolation, according to a recent Washington Post article, as medical professionals report concern that delayed screenings have allowed cancer cases to progress beyond early-stage treatment.
Meanwhile, virtual communication has come into play in a big way in cancer medicine. After in-person mammograms, Yee sees the trend of telemedicine for follow-up continuing beyond the pandemic. Telemedicine makes it easier for second opinions and referrals for patients, communication between hospitals and, in the example of the 90-year-old he cited, more access to a wider pool of family members. “No question: telemedicine will change our practice patterns,” he says. “If you went back to the beginning of 2020 and wanted to do a video visit, in many cases there was no way to coordinate that with medical records and the access you need.”
For all the advances in technology, Yee reminds us that in-person interaction can also be crucial in the exam room as well as in life. “Maybe it’s a cliché, but there’s such a thing as a healing touch,” Yee says. “People will always need human connection.”