Maria Kefalas considers her husband, Patrick Carr, a forgotten victim of the coronavirus.
In January, Mr. Carr, a sociology professor at Rutgers University, suffered a relapse of the blood cancer that he has had for eight years. Once again, he required chemotherapy to try to bring the disease, multiple myeloma, under control.
But this time, as the coronavirus began raging through Philadelphia, blood supplies were rationed and he couldn’t get enough of the transfusions needed to alleviate his anemia and allow chemo to begin. Clinic visits were canceled even as his condition worsened.
For Mr. Carr and many others, the pandemic has shaken every aspect of health care, including cancer, organ transplants and even brain surgery.
On 7, Mr. Carr began receiving home hospice care. He died on April 25. He was 71. The pandemic “expedited his death,” Ms. Kefalas said.
“I’m not saying he would have beaten the cancer, ”said Ms. Kefalas, a professor of sociology at St. Catherine. Joseph’s University in Philadelphia. “I’m saying it wouldn’t have been been four months, this precipitous decline, fighting for blood, fighting for hospice nurses.”
“People like my husband now are dying not because of Covid, but because the health care system just cracked open and swallowed them up, ”she said.
Beds , blood, doctors, nurses and ventilators are in short supply; operating rooms are being turned into intensive care units; and surgeons have been redeployed to treat people who cannot breathe. Even if there is room for other patients, medical centers hesitate to bring them in unless it is absolutely necessary, for fear of infecting them – or of health workers being infected by them. Patients themselves are afraid to set foot in the hospital even if they are really sick. Early on, as the epidemic loomed, many hospitals took the common-sense step of halting elective surgery . Knee replacements, face lifts and most hernias could wait. So could checkups and routine mammograms.
But some conditions fall into a gray zone of medical risk. While they may not be emergencies, many of these illnesses could become life threatening, or if not quickly treated, leave the patient with permanent disability. Doctors and patients alike are confronted with a worrisome future: How long is too long to postpone medical care or treatment?
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Delaying treatment is especially disturbing for people with cancer, in no small part because it seems to contradict years of public health messages urging everyone to find the disease early and treat it as soon as possible . Doctors say they are trying to provide only the most urgently needed cancer care in clinics or hospitals, not just to conserve resources but also to protect cancer patients, who have high odds of becoming severely ill if they contract the coronavirus.
Nearly one in four cancer patients reported delays in their care because of the pandemic, including access to in-person appointments, imaging, surgery and other services, according to a (recent survey by the American Cancer Society’s Cancer Action Network.
Tzvia Bader, who leads the company TrialJectory , which helps cancer patients find clinical trials, said frightened patients had been calling to ask her advice about postponements in their treatment.
One woman had undergone surgery for melanoma that had spread to her liver, and was due to begin immunotherapy, but was told it would be delayed for an unknown length of time.
“She says, ‘What’s going to happen to me?’” Ms. Bader said. “This is not improving her chances.”
And some clinical trials, where cancer patients can receive innovative therapies, have been suspended.
“The mortality of cancer has been declining over the last few years, and I’m so terrified we are going backwards,” Ms. Bader said.
Many hospitals have postponed surgery for breast tumors, an unsettling decision for women eager to have the cancer removed. But oncologists say that for most cases of breast cancer, unlike more aggressive malignancies, there is no harm in waiting for surgery, because the regimen can be changed.
“We can safely give drugs first and start the surgery later,” said Dr. Larry Norton, medical director of the Evelyn H. Lauder Breast Center at the Memorial Sloan Kettering Cancer Center in New York. “The current crisis will be under control, and they can come back later.”
The drugs include hormone-blocking medicines or chemotherapy, depending on the type of tumor. Even before the pandemic, some treatment plans called for drugs first and surgery later.
But patients first may need some convincing that it’s OK to change the plan.
Women scheduled for radiation may also be able to wait, according to Dr. Sylvia Adams, director of the breast cancer center at NYU Langone’s Perlmutter Cancer Center.
But she added in an email: “Patients who need radiation urgently (such as for brain or spine metastases from breast cancer) will be able to undergo radiotherapy. Radiation oncologists are also trying to use shorter regimens whenever possible to minimize the number of trips a patient must take for radiation. ”
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