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For Cancer Patients, Anguish Grows Over Deferred Surgery As Risk Rises


COVID-19 has taken the medical focus away from other serious diseases, including cancer. The American Cancer Society finds that more than a quarter of patients report delays in treatment. NPR's Yuki Noguchi reports on the impact.

YUKI NOGUCHI, BYLINE: Days after her 40th birthday, Silver felt a lump in her left breast. It was a tumor that spread to her lung and liver. Eight months of chemotherapy reduced them to operable size. But last month her oncologist explained a mastectomy would also require an additional procedure.

SILVER: She needs to take so much skin off, she needed to put a flap on it. So they need to take some skin off my back. Flaps are considered plastic surgery. So all plastic surgery is banned, so no surgery.

NOGUCHI: Surgeries deemed nonessential were shut down.

SILVER: It's not necessarily considered a medical emergency by them even though it's, like, the entire world to me.

NOGUCHI: A world that includes two young sons and a husband. Silver, who withheld her last name for medical privacy, felt shattered. She faced the devastation without friends to hug.

SILVER: You know, my one hope to be a long-term survivor was kind of fading. And now I'm going to have to pioneer a new hope. That was tough. It was awful.

NOGUCHI: The pandemic is creating bottlenecks in care that ripple through other areas of medicine. People with psychiatric disorders and even heart trouble or strokes are avoiding hospitals for fear of infection. Cancer screenings are down. Many conditions will worsen while the health system diverts to fight the virus. For Silver, delays are excruciating. Her oncologist suggested a new chemo until surgery is possible.

SILVER: But in order to change the chemo, we needed to rebiopsy. Now, there was a delay in getting a rebiopsy because there's less staff.

NOGUCHI: And that's not all. Insurance approvals take longer with agents working from home. The chemo center takes fewer patients in order to space them further apart. All this drains precious time.

SILVER: In the five-week delay, I had gone from three small tumors to a massive, like, seven-by-three tumor that was pushing against the skin.

NOGUCHI: Ravi Parikh is an oncologist at the University of Pennsylvania. He says recent months forced him to embrace the previously unthinkable, like in-home chemotherapy and telephonic patient visits. Workarounds like that, he says, will need to continue.

RAVI PARIKH: The No. 1 thing that I'm concerned about is the backlog of cases. When there's this onslaught of appointments, surgeries, colonoscopies, chemotherapy appointments, it's not going to be at a slow pace.

NOGUCHI: There are other worries, too. As many states reopen, cancer patients are at greater risk of infection. Len Lichtenfeld is deputy chief medical officer of the American Cancer Society. He says local infection rates vary widely, so doctors have to weigh when it's safe to operate.

LEN LICHTENFELD: They're going to have to make the decisions that are right for that community, understanding that what's true for one town or city may not be true for a town or city in another part of the same state.

NOGUCHI: Then deciding who to treat first is yet another challenge.

LICHTENFELD: It's critically important that we understand what care takes priority.

NOGUCHI: Some are trying to manage that. Michael Sabel is a surgical oncologist with the University of Michigan. His hospital uses several factors to calculate what they call a patient's urgency score.

MICHAEL SABEL: In many cases, that can include patients being able to get back to work and the financial strain that's on patients in addition to just things like, is it cancer, and what is the biology of that cancer?

NOGUCHI: The frustrating reality is that COVID will continue delaying care for some time. Silver, the cancer patient, has set her sights on new goals - to shrink the tumors with a new chemo, to reschedule surgery for the fall.

SILVER: I hope it works. It's what I have right now, and I just hope it works.

NOGUCHI: Yuki Noguchi, NPR News.

(SOUNDBITE OF THE TIDES' "SUBTLE DREAMS") Transcript provided by NPR, Copyright NPR.

Yuki Noguchi is a correspondent on the Science Desk based out of NPR's headquarters in Washington, D.C. She started covering consumer health in the midst of the pandemic, reporting on everything from vaccination and racial inequities in access to health, to cancer care, obesity and mental health.