Are cancer surgeries 'elective' or life-saving? Some awaiting operations are in limbo due to COVID-19

The Ontario government's directive to hospitals to perform only emergency and life-saving surgeries has left people getting certain types of cancer treatments in limbo because they say their surgeries are considered elective.

Lisa Scott's 33-year-old daughter Vanessa Scott Fisher was diagnosed with breast cancer a year ago. She was scheduled to have surgery to have her ovaries removed, but this week she was told that's been postponed indefinitely.

"It's not elective. I mean, it's not like you ... sign up to get those removed, right? Scott said. 

"You don't do that unless you're doing it for life saving reasons."

As Ontario intensive care units become overwhelmed with growing numbers of patients battling COVID-19 during the third wave of the pandemic, hospitals have been ordered to postpone elective surgeries to create capacity. The instruction came in a memo from Ontario Health issued on April 8.

Some emergency surgeries for such things as cardiac problems and trauma due to an automobile accident can't be postponed, but some operations, such as hip replacements, can be delayed.

Scott is at a loss to explain why her daughter's case falls into the latter category and she's started a petition to have these kinds of procedures recognized as 'life-saving."

"Their cancer is estrogen-fuelled. So your ovaries produce estrogen and so the surgery is to stop estrogen being produced in your body. Going for six to eight weeks or whatever potentially could fuel cancer growth again."

Natalie Mehra, the executive director of the Ontario Health Coalition, says it didn't have to come to this. She says the province could have avoided it if it had tightened public health restrictions over the past few months, instead of lifting province-wide emergency stay-at-home orders and easing lockdowns in some regions.

"Surgeons are going through their lists and they are doing the heartbreaking horrible work of figuring out whose surgery is imminently life saving," she said.

Mehra says that will mean the province's surgical backlog, which is already close to 250,000 procedures, will continue to grow. She says many are medically necessary operations and many of these patients are suffering as they wait for appointments to be rescheduled.

"I think the word elective makes people think that you know you could have it or you couldn't have it, and things will be all right either way and that's really not what it means," said Mehra.

And there's the mental and emotional toll of delaying cancer surgeries or any operations that are leaving people waiting in pain. It's a terrible situation. It is just a terrible situation all around."

In a statement to CBC, Ontario Health says it is not possible to provide the number of surgeries backlogged due to the COVID-19 pandemic, but it did provide data for completed surgeries during the pre-pandemic and pandemic periods. 

From March 15, 2020 to April 4, 2021, 467,211 surgeries were completed in Ontario, down from the 680,399 surgeries that were completed from the same period between 2019 and 2020. That includes all oncology, all adult non-oncology and all pediatric surgeries, but not cardiac and transplant operations. 

Dr. Aisha Lofters, the chair of Implementation Science at the Peter Gilgan Centre for Women's Cancers at Women's College Hospital, says people undergoing cancer treatment who have had their procedures postponed are understandably anxious and upset. 

"If the surgery is being postponed, it's not because it's considered trivial or considered unimportant, that's not what the message should be," she said. 

"The message really is that things are so bad in our system right now that the system is not able to accommodate the surgeries and procedures actually are very important."

She says everyone should follow the measures to reduce the spread of COVID-19 to improve ICU numbers and allow surgeries to resume, hopefully over the next few weeks.

In a statement to CBC Toronto, Stephen Piazza, the senior manager for advocacy at the Canadian Cancer Society, says the best way to help people with cancer is to end this pandemic.

He says screening, surgeries and interventions essential to cancer care have been postponed since the pandemic began last year, and disruptions are happening once again in Ontario and other regions of the country.

"We are concerned that we will see cancer cases diagnosed or treated too late. We continue to keep decision makers informed of the impacts of postponed care and encourage the public to follow public health guidance so cancer care can be resumed as soon as possible."

Meanwhile, Lisa Scott is worried about her daughter's prognosis once treatment resumes.

"She just came through a whole bunch of tests that they did in preparation for her surgery, scans and so on," she said.

"Now it's likely that she'll have to have all of those tests repeated again in order to prepare for whenever they do get around to scheduling her surgery."