As South Africa finally heads towards level 1 of the lockdown at midnight tomorrow, there are now fears that the country could be sitting on a time bomb of undetected cancer cases.
Scores of South Africans have been unable to be screened for cancers during the six-month long quarantine, delaying diagnosis for an array of different cancers – some potentially fatal.
Gauteng could be the worst hit, believes veteran DA provincial health spokesperson Jack Bloom, after its hospitals were inundated by a high CVOVID 19 caseload.
“The issue with cancer is that you can have a symptom like back pain which could just be a muscle problem or it could be cancer, but you won’t know until you go to a doctor but this has been challenging during the lockdown.”
“In Gauteng, it was even worse getting medical attention because the hospital was so full with Covid-19 patients and so many people in the province depend on public transport even to go to the hospital which was challenging during the lockdown.”
“Gauteng hospitals treat patients from other provinces as well and we actually had an inter-provincial ban which made travelling difficult.”
Discovery Health Medical Scheme has noted a dramatic drop year-on-year on the number of cancer referrals. “This is a direct consequence of the Covid-19 pandemic and the lockdown,” Noluthando Nematswerani, head of Discovery Health’s Centre for Clinical Excellence said.
Nematswerani said there had been a 60% reduction in doctor consultations for cancer patients during level 5 of the lockdown but she said this trend returned to previous year’s level by June 2020.
The scheme recorded 51% fewer mammograms towards the end of March 2020 compared to the same period last year. “This was associated with a corresponding 44% reduction in the number of breast cancer diagnoses and an overall 53% reduction in cancer registrations during this period.
“With most elective surgical procedures deferred during the pandemic period, this would have contributed to the reduction in cancer diagnosis.”
Many current cancer sufferers received inadequate treatment during the lockdown. Experts believe that many patients reluctantly postponed treatments at medical facilities over fears that they might contract the coronavirus and that their compromised immune systems would see them facing severe to deadly infections.
“Some patients are quite afraid as they are very vulnerable due to their low immune system and therefore patients are postponing cancer treatment,” the Cancer Association of South Africa’s (CANSA) head of advocacy, Zodwa Sithole said.
The head of Cancer Alliance Linda Greef agreed: “This is a huge dilemma as cancer patients who do not have access to timeous treatment will have illness progression and as such their prognosis is negatively impacted.”
Nematswerani said Discovery noted a 7% increased risk of their members who were admitted to hospital for the coronavirus. “A 22% increased risk of death has also been observed in actively managed oncology patients with a confirmed Covid-19 infection in line with findings already described in published literature.”
But it was not just cancer patients who decided to delay their treatments. Sithole said there had been cases where cancer patients were turned away from various medical facilities struggling to cope with the influx of coronavirus cases.
“Patients in some areas were attended to, though at times they were told to stay away and were called on specific dates, in an attempt to control the number of patients in one place at any time and lessen the risk.”
Bloom added that he received distressing calls from cancer patients who were unable to receive treatment and that in some of these instances their lives had been at risk. “I think these delays have been quite disruptive, distressing and possibly life-threatening.”
But Nematswerani said that Discovery members who had been diagnosed with cancer have continued to access out-of-hospital treatment throughout the lockdown.
She explained that this was possible as most chemotherapy and radiation facilities are located in premises separate from hospital units. They also implemented stringent Covid-19 precautionary measures in order to protect patients.
“Surgical management of cancer may have been impacted by the reduction in the number of elective procedures during the lockdown period but emergency and urgent surgical care remained available to members during this period.”
There have also been widespread instances where medical practitioners were unable to treat cancer patients as they themselves were some of the many frontline Department of Health workers who had contracted COVID 19, ending up in mandatory quarantine, said Sithole.
Experts have also agreed that shortages on several fronts has meant that the country was battling to curb cancer cases even prior to the global health crisis and that the novel coronavirus simply made matters worse.
“There is also a general shortage of certain chemo medication due to lockdown and the cutting back of import and exports at global borders, said Sithole.
“This would also apply to obtaining parts for some of the machines needed in the treatment of cancer patients.”
Greef also noted shortages of cancer drugs but said issues with oncology services in the country have also been alarming.
“Oncology trained staff are in short supply and during the pandemic they were also impacted and this disrupted the access to care, causing long backlogs in preventative surgery.”
“More staff needs to be appointed to reduce the backlogs which are causing people to die.”
Now health professionals are calling for people to get screened for cancer. Nematswerani said this was vital because it allowed not just for early diagnosis and treatment, but also a significant survival benefit for the patient and reduced healthcare costs by minimising the need for advanced cancer treatment.