Cancer Surgeries & Organ Transplants Put Off For Coronavirus. Can They Wait? ProPublica
'Cancer Surgeries and Organ Transplants Are Being Put Off for Coronavirus. Can They Wait?' In a given month, more than a million people have some kind of surgery. The elective procedures being postponed because of coronavirus aren’t all optional. Cancer patients and organ recipients are being forced to wait. By Joanne Lipman for ProPublica, April 6, 2020.
San Francisco Bay Area surgeon Mary Cardoza is juggling multiple breast cancer patients. But she can’t operate on any of them. Breast cancer surgery, it turns out, is considered an elective procedure — now put on hold as hospitals focus on COVID-19 cases. On March 13, the American College of Surgeons called on physicians to halt nonessential procedures. But what, exactly, is an elective procedure? Like many people, I assumed it meant facelifts or perhaps knee replacements that could be delayed without damage. And like many people, I was wrong.
Elective surgery is, by definition, any surgery that is scheduled. That means cancer surgery, organ transplants and other lifesaving procedures, all of which are now put on hold — in some cases indefinitely.
Since making its initial recommendation, the American College of Surgeons has been issuing increasingly urgent bulletins, with its March 24 missive detailing triage guidelines for cancer, cardiac and pediatric surgeries. It now finds itself in the grim position of recommending that removal of cancerous colon polyps be deferred for three months and breast cancer surgery be delayed if the disease responds to hormone therapy. In hospitals with heavy COVID-19 caseloads — those with no spare ventilators or ICU capacity — it urges that all surgical procedures be avoided unless the patient is likely to die within the next few hours or days.
The guidelines specify that treatment shouldn’t be delayed if it would harm the patient. That’s small solace to people like Russell Green. In March, the 63-year-old Vermont financial adviser was diagnosed with “aggressive” prostate cancer and advised to schedule surgery as soon as possible. But after the coronavirus hit, his April 22 surgery date was canceled. “I hear this. And I think, well, this isn’t elective. It’s aggressive cancer,” Green told Vermont Public Radio, the local NPR affiliate. “And you want to get rid of the thing, that’s not elective.” Green pushed back, and his surgery is now on the calendar again, at least for the moment. But it’s difficult to know what the future holds.
The tragedy is, the suspension isn’t always due to a lack of capacity to treat patients. Instead, it’s a side effect of the lack of protective equipment — the precious masks and gowns that are in short supply and are being redirected to those treating highly infectious COVID-19. Hospitals with a large number of those cases are also trying to preserve ventilators and ICU beds for patients with the virus. And doctors are concerned as well about bringing patients who may already be immunocompromised into hospitals where they may be exposed to the virus.
As a breast cancer survivor myself, I know the sense of urgency after being diagnosed. The anxiety and fear is hard to overstate, the feeling of just wanting to get rid of a cancer growing within you. In my case, I was in surgery within days...
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