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SocietySeptember 28, 2021

Is Covid-19 really compromising our hospitals’ cancer care?

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Last week two media outlets claimed ‘almost half of new cancers’ went undetected because of the Covid lockdowns last year – and that it could be happening again now. Is it?

This story first appeared on RNZ. Listen to the original Mediawatch episode here.

Auckland University’s emeritus professor Des Gorman has been a vocal critic of the government’s Covid-19 response so far.

“We have a mortal fear of dying of Covid and yet we allow delayed surgery and delayed cancer care,” he told Newstalk ZB last Monday.

Host Mike Hosking agreed.

“We have lost our marbles when it comes to health matters in this country. We are more gripped by whether people end up in hospital with Covid … when there are people dying of cancer that couldn’t be treated and haven’t been,” Hosking told his listeners soon after.

“The Cancer Control Agency was yesterday talking about how half of new cancer cases are going to be missed,” he added.

Hosking had two stark stats at hand from the CCA / Te Aho o Te Kahu to make the point: 1031 fewer cases recorded compared to the same period the year before – a 47% drop.

Worrying stuff, especially as we’ve had an even longer lockdown this year – and Auckland is still in alert level three now.

Backlogs over lockdowns of 2020 at various district health boards have been reported by the media in the past, but Hosking didn’t mention that the 47% drop covered just one month: April 2020, our first month ever in level four when disruption was at its peak.

Cancer diagnoses dropping off in early 2020
Cancer diagnoses dropping off in early 2020 (Image: Cancer Control Agency report 2020)

But the same CCA report that recorded the big drop also found that cancer registrations only decreased by about 7% in the first four months of 2020 when compared with the same period in 2019.

Attendances for intravenous chemotherapy were down just 3% in April 2020 – and were stable over the rest of the 2020 lockdown.

A CCA update in August 2020 found a substantial increase in new cancer registrations and diagnostic procedures in June 2020 compared to May 2020, and 225 people were beginning treatment.

A longer assessment in The Lancet later in the 2020 found “the impact of Covid-19 on cancer care in New Zealand had been largely mitigated”.

“Overall, there is no evidence of lingering disruption to cancer registration, diagnostic services or treatment following the early shutdown,” concluded nine experts including Dr Chris Jackson, the Cancer Society’s long-serving medical director.

CCA chief executive Dr Diana Sarfati told Mediawatch neither she nor the CCA has ever said “about half of new cancer cases are going to be missed,” as Hosking claimed on Newstalk ZB.

It seems likely he misread a Stuff story the day before which appeared in papers nationwide: Covid and the hundreds of missed cancers.

“New Zealand will emerge from lockdown into a deadly unknown … with history showing nearly half of new cancer cases will have been missed,” the story said.

Online, the headline of Stuff’s story is a bit more nuanced: Missing lockdown cancers yet to be measured – but history paints ominous picture.

But more recent history is actually not so ominous, according to the CCA.

“The country’s cancer system is operating well, and people are receiving the treatment they need,” Sarfati​ said earlier this month during the level four period.

She said all district health boards were doing essential cancer treatment and surgery during the current outbreak and travelling between regions in alert levels three and four is allowed for essential cancer appointments.

“I would be concerned if people had the impression cancer treatment stopped as a result of lockdown because that is not accurate,” Sarfati told Mediawatch.

She said it is too soon to say if “cancers are being missed” in the current outbreak but CCA “is again measuring cancer services in response to the re-emergence of Covid-19 to see if there has been a decline in diagnosis of cancer”.

The data will be available next month.

“We would not expert to see such a substantial drop-off as we saw in the lockdown last time,” she said.

The reason all this caught the attention of Stuff – and Mike Hosking’s jaundiced eye – in the first place was a fresh CCA campaign urging people to go to their doctor, even during lockdown, if they notice symptoms.

Let’s hope more people get that message rather than the overstated assumptions about life-shortening delays and disruptions in the media last week.

Last Tuesday Hosking also told his listeners:

“Australia is the one to emulate. Of course we could be leading Australia if we were driven – but we are not. We are cowed and run by fear.”

But one thing about Australia we wouldn’t want to emulate right now is its cancer treatment disruption, judging by media reports.

Two weeks ago Melbourne’s main daily The Age reported “life-saving treatments for cardiac and cancer patients are already being delayed … as waiting lists blow out to record levels”.

The Covid-19 Cancer Taskforce chair for Victoria told the paper cancer surgeries were already being delayed because people were being treated for coronavirus.

“More than 2500 cancer diagnoses were missed in Victoria between April and October last year, with a steep fall in the detection of prostate, skin and breast cancers, along with head and neck tumours,” The Age reported.

The Sydney Morning Herald recently reported one in every five people who have died of Covid in New South Wales contracted it in its hospitals – and two cancer treatment centres became exposure sites in the current outbreak.

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