Amy McNally, MD, is chair of The US Oncology Network’s Surgery Advisory Council. She is in practice with Minnesota Oncology.
Federal and state officials have implemented policies and safeguards to slow transmission of the virus. Most troubling were state moratoriums on “elective” surgical procedures.
For much of the general public, avoiding coronavirus disease 2019 (COVID-19) is the most significant health issue they are having to face. Americans are consumed with the statistics surrounding new cases and deaths, while grappling with the social and economic impacts of the virus. Collectively we wait, try to protect ourselves and our families, and hope that a persistent downward trend will mean a return to normal life.
But even though safeguarding against and caring for Americans with coronavirus is of upmost importance, other deadly health conditions have not disappeared. When the dust from the COVID-19 pandemic settles, we will almost certainly see a silent and underrepresented casualty of the crisis: Patients with cancer whose diagnosis, access to care, and treatment have been negatively affected due to the pandemic response.
Both the federal government and state officials have implemented policies and safeguards to slow transmission of the virus. Perhaps most troubling in this new environment were the state moratoriums on “elective” surgical procedures.1 Lack of personal protective equipment (PPE) and inadequate supplies of dependable rapid COVID testing further forced hospitals, surgical centers, and health care systems to restrict access to care and services to anything other than emergent cases in many settings. The process has been chaotic and inconsistent, with major differences even existing within the same city between hospitals only miles apart.
As a practicing surgeon and chair of The US Oncology Network’s Surgery Advisory Council who works alongside more than 190 surgeons across the country, I have witnessed firsthand the abrupt and widespread impact these actions have had on the care of our patients. For many patients with cancer, surgery is the first step in diagnosis, if not a critical component of achieving cure. Surgical procedures do not have to be emergent to play an important part in a patient’s overall well-being and care.
Thousands of nonelective surgical cases were cancelled or delayed in our network of surgeons alone. Although the restriction of certain elective procedures has been critically necessary to reduce the risk of exposure and spread of the virus, to ensure adequate supplies of protective equipment, and to maintain capacity of beds and intensive care units, it has also affected the care of those living with cancer. Rising unemployment, loss of insurance, and delays in potentially diagnostic/curative surgical therapy will have the most immediate impact.
However, I anticipate a longer-term impact due to those patients who remain at home fearfully avoiding workup of their cancer symptoms, unable to get access to their primary care providers or who are waiting for their cancelled cancer screening tests to be rescheduled. These disruptions in care will result in further strain on our health care system in the coming months and years due to an influx of patients presenting with advanced stage cancers.
This in turn will lead to higher health care costs and missed opportunities for curative therapy. The COVID-19 pandemic has forced all of us to reexamine how we approach cancer care in this country. As advocates for our surgical patients, and the cancer community at large, we acknowledge there is an urgent need for a broader understanding and agreement on how to best serve our patients in times of limited resources and significant public health risk. The patchwork of inconsistent policies and regulations from state to state and health care system to health care system has led to widespread confusion and, I fear, devastating impacts on patient outcomes and health care costs.
In response, surgeons across The US Oncology Network, which treats nearly a million Americans across 470 locations in 25 states each year, have developed guiding principles to inform lawmakers and health care leaders as they work together to ensure timely treatment for anyone who needs a surgery as part of their cancer care.2 First and foremost, a patient’s need for surgery should primarily be at the discretion of the surgeon.
As my patients’ surgeon, I am most well equipped to make decisions about the course of their care. It is crucial that cancer surgery or surgery for potential cancer be identified within their own category of prioritization and not as elective surgeries for these patients. As mandates on elective surgeries are lifted, cancer surgeries must be uniformly prioritized.
To avoid further unnecessary delays in care, insurance providers must extend prior authorizations for patients with cancer who had their previously scheduled procedures cancelled, and also preauthorize all patients who had their surgeries delayed or who not yet have a confirmed surgery date. Additionally, policy makers should consider options to bridge coverage gaps to ensure seamless cancer care for patients dealing with job loss or for patients already suffering with the logistical barriers of being uninsured during this crisis.
Furthermore, patients must feel confident that they can safely seek treatment. As surgeons in The US Oncology Network, we have rapidly adapted to our new COVID-19 reality in many ways to ensure the safety of our patients, our staff, and ourselves.
We are embracing telehealth, establishing clinical guidelines, reconfiguring offices, and following recommended use of PPE. However, it is not the sole responsibility of the individual surgeon to ensure that adequate protective equipment and hospital resources are available to provide safe surgeries to our patients with cancer. Hospitals and surgical centers must take the necessary measures to protect our patients’ health and safety by, at a minimum, having adequate supplies of personal protective equipment and sufficient access to rapid COVID testing.
As we weather this crisis and move forward, we must heed the lessons we have learned. There have been many. There will be more to come. We should embrace this opportunity to sit at the table so we can learn how to provide better care for our patients and to minimize the cost to our society. As a cancer surgeon, we need a seat at the table.
Amy McNally, MD, is the chair of The US Oncology Network’s Surgery Advisory Council. She is in practice with Minnesota Oncology.
1. Ambulatory Surgery Center Association. State guidance on elective surgeries. Updated April 20, 2020. Accessed July 13, 2020. https://www.ascassociation.org/asca/resourcecenter/latestnewsresourcecenter/covid-19/covid-19-state
2. The US Oncology Network. Principles to guide surgical care during COVID-19. Accessed July 13, 2020. https://legislink.com/wp-content/uploads/2020/05/The-Network-Principles-to-Guide-Surgical-Care-COVID-19-.pdf