Specialists prepare for difficult decisions on deferred patient care in pandemic


Dr Deme Karikios

Specialists are steeling themselves to make tough decisions about rationing cancer care as the COVID-19 pandemic continues to gather pace.

While COVID-19 case numbers and hospitalisations remain well short of the projected peak, Sydney oncologist Dr Deme Karikios says the growing outbreaks in the two most populous states are already squeezing hospitals’ ability to deliver care where it is needed.

“We are concerned to see the impact COVID is having in NSW and probably in Victoria too.  The number of cases in hospitals is rising and that’s having an impact on all services across the hospitals,“ he told the limbic.

Dr Karikios, president of the Medical Oncology Group of Australia (MOGA), said services were necessarily being curtailed as hospitals redeployed staff and resources for the urgent cause of battling COVID, and clinicians were preparing for more challenges ahead.

“Right now, I know that oncologists, quite appropriately – radiation oncologists, medical oncologists, haematologists – are considering which patients they could defer starting treatment on, which patients they could stop treatment safely on,” he said.

“So, if servIces should happen to be cut back, they know who to suggest that to.

“What we are saying to patients is that ideally we want to continue your treatment but we might not be able to.  So we can perhaps suggest you have a break, or stop treatment, or don’t start treatment, perhaps put it off for a few months.

“We would always try to do that safely and effectively, but we can’t always get it perfectly right.”

The prospect of rationing cancer care was “difficult and distressing” for oncologists but may be unavoidable.

In the first wave of the pandemic in 2020, redeployments drew from non-acute services and cancer treatment was barely disrupted.  But the current outbreak, driven by the Delta strain of the coronavirus, is a different matter.

“For example, chemotherapy nurses being redeployed to areas of need in a hospital, so less chemotherapy can be provided,” Dr Karikios said.

“Doctors at all levels are being redeployed – again, very necessarily – which means that either the doctors left behind are doing more work or they are not able to do as much work.”

In other signs of strain, COVID measures are also impeding access to scans, diagnostic tests, follow-up colonoscopies for bowel cancer patients and acute care in the community.

While these measures were sensible and necessary for safety and other reasons, along with the suspension of non-essential surgeries, there is concern about far-reaching flow-on effects in the health system.

“I have total respect for the decision makers making these difficult decisions in these situations, because it must be incredibly challenging,” the MOGA president said.

“But what we should highlight is, we don’t want unintended consequences from a re-allocation of resources which has a good effect in some areas but a negative effect in others.”

Oncologists are “incredibly worried” about the impact on cancer care if the COVID crisis is prolonged, he said.

“While we will strive to deliver these (cancer) services as best we can, we are all a bit fearful that over the coming weeks and months we might not be able to provide the standard we are used to providing.

“I feel particularly for people at the end of their life and who may be not able to have the ideal care they would normally be provided. But they are also not having the contact they need, not only with their healthcare providers but also their relatives and friends.”

As previously reported in the limbic, some oncology departments have already been shut down or had to refuse new admissions after being hit by COVID-19 infections.

As of 13 September, Australia had 17,909 active cases of COVID-19, and 1378 people were hospitalised. Rates continue to increase with 1381 new locally acquired cases reported nationally on 13 September.  The Federal health department does not release statistics on whole population rates of vaccination, but reports that 42.6% of eligible people have been fully vaccinated.

 

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