COVID-19 creates cancer care backlogs that could take years for Nova Scotia to resolve

The senior medical director of Nova Scotia's cancer care program says it will be several years before backlogs in the system related to COVID-19 can be addressed, and even then, there will be long-term implications for patients.

"I don't think we can look at this as reaching a peak and then quickly things will get back to normal," Dr. Helmut Hollenhorst said in an interview Monday.

"Even if COVID suddenly disappears tomorrow, it will take years to catch up with the backlog and to rebuild the system."

Hollenhorst said the pandemic has only exacerbated a problem that already existed, and it is one that's common among cancer programs in the country: insufficient resources.

Spikes in COVID-19 cases in the last two years have resulted in periods where various treatments, procedures and clinics were either outright cancelled or scaled back in Nova Scotia. Cancer care has been no different, although urgent surgeries went ahead whenever possible.

Surgeries postponed when beds not available

But during the Omicron wave of COVID-19, which has seen record highs of people hospitalized in the province either with or because of the disease, Hollenhorst said there have been complications for cancer patients awaiting surgery.

"Patients having big surgeries would require ICU beds, and if these beds are not available, the surgery cannot go ahead and the treatment will be cancelled and the patient would be rebooked as soon as possible," he said.

The situation has been further challenged by staff availability. Hollenhorst said during the fourth wave, staffing levels in the cancer program have been down by as much as 25 per cent due to a combination of people being required to isolate and others being redeployed within the system to areas such as emergency departments, COVID-19 units and long-term care.

The system has also lost a lot of experienced, sub-specialized health-care workers to retirement and burnout, said Hollenhorst. While the bodies can be replaced, it takes time to replace the lost experience and expertise.

"All of us, we are in cancer care because we want to help patients and we want to provide care, and we continue to do this. But our resources and our systems are very strained and our heath-care professionals are tired," he said.

'COVID will cost lives'

One of the biggest challenges throughout the pandemic for cancer patients has been timely access to testing, such as biopsies, screening and diagnostic imaging.

In some instances, Hollenhorst said people have also put off visiting the doctor or hospital out of fear of encountering COVID-19, leading to the late detection of cancers that otherwise might have been caught in the early stages.

Ongoing national modelling paints a concerning picture.

"The impact of COVID will cost lives," said Hollenhorst.

Reducing the potential impacts will require increasing scope of service and accessibility, and that requires resources. Aside from bringing more workers into the system, it also means ensuring people are working to full scope of practice.

New ways of doing things

Like other areas of health care, Hollenhorst said cancer care has benefited from being forced to find different ways to work during the pandemic.

Telephone and virtual appointments, when appropriate, can save patients hours of driving to get to a doctor. Some treatment protocols have also been modified in keeping with evidence and research. Some radiation treatment, for example, is being done in shorter courses, but at higher doses using high-precision imaging and other technology.

The approach, which was only beginning to emerge before the pandemic, means patients getting treatment delivered in shorter time periods, being away from home for less time, and reducing the amount of time they're exposed to radiation, said Hollenhorst.

Another change is having primary care providers handle radiation oncology followups for patients when their treatment is complete. Hollenhorst said emerging research shows the outcomes are just as good and it frees up more specialized staff to do other things.

'We need to act'

For example, specialized nurses are running a supportive care unit that helps patients in active treatment to identify any problems and help mitigate them.

"As a result of that, the admission rates in hospital and the visits to the emergency department have significantly gone down," said Hollenhorst.

It also means less suffering for patients and an easier time going through the system, he said.

For all the bright spots, though, concerns abound. Cancer doesn't wait and any kind of delay in diagnosis and treatment is not good, said Hollenhorst.

"We need to act," he said, "and we need to act now if we want to have better outcomes for our cancer patients."

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