*This OpEd featured in the Irish Examiner on World Cancer Day 2021 and is reprinted with permission.
As a cancer doctor, the ability to connect and relate to a patient is dependent on regular face-to-face encounters. It allows us to meet, talk and see how a person is feeling.
This exchange of body language and eye contact was a routine part of our work for every patient up until less than 12 months ago. We now have fewer opportunities for these crucial, but sometimes intangible moments as we often need to assess patients over the telephone or even need to defer appointments.
This is just one of the many impacts the Covid pandemic has had on cancer care.
In order to protect patients and staff, we have needed to decrease footfall in the hospitals, wear personal protective equipment (PPE) for much of our routine work, decrease meetings with colleagues to discuss detailed aspects of patient care and sometimes redeploy scarce staff to Covid care. Many of us involved in cancer care have volunteered to work shifts in the ICU to care for patients suffering from Covid-related illness.
Across Ireland and the world the above measures have decreased access to clinic appointments and investigations which allow earlier diagnosis of cancer. Access to timely surgery to remove cancers has slowed. The reconfiguration of space within hospitals and the reduced ability for home visits has impacted Palliative Care services.
In the main, very urgent work has continued. Chemotherapy and radiotherapy have continued to be administered but every department across the continuum of cancer care has been hit by staff shortages due to Covid-related issues with subsequent effect on care. The cumulative effect of these barriers to timely and effective cancer care will take years to accurately quantify but estimates from the UK suggest at least 3000 extra cancer deaths are expected there in the next five years due to delays in the past 12 months.
Lessons can be learned from our experiences. The co-location of acute unscheduled emergency healthcare with scheduled care such as cancer surgery has highlighted the vulnerability of our healthcare system. A focus is needed to develop infrastructure which allows these two strands of healthcare to progress in parallel together. This would allow both to function most efficiently so that scheduled care can be properly planned regardless of the unpredictable rise and fall of emergency work. Novel cancer drugs such as immunotherapy and targeted therapy give our patients access to more effective and less toxic treatments which lower the risk of needing hospitalisation and indeed lower the risk of contracting Covid as they are less immunosuppressive than conventional chemotherapy. Many can be given in tablet form.
However, this week the HSE has approved a number of novel medications for use in cancer care which is a very welcome development and we hope this is the start of a concerted effort to bring us up to par in that regard.
Throughout the last twelve months we have continued to prioritise our efforts to give patients access to cancer clinical trials. This allows our patients access the most cutting-edge cancer therapies often before they are approved or funded for use in the standard of care setting.
The ongoing efforts of laboratory researchers must also be supported so that we eventually reach our ultimate goal of preventing illness and death from this disease. Cancer was the leading cause of death in Ireland last year with five times as many patients succumbing to the illness compared with Covid-19. We must bear this in mind as we endeavour to keep our cancer care system running in these unprecedented times.