Coronavirus: cancelling elective surgeries prolonging cancer treatment

Leading cancer surgeons have warned that delaying surgery deemed of lower urgency due to Covid-19 is putting lives at risk.

Brisbane teacher Laura van Zyl, 57, is still waiting for her post-mastectomy breast reconstruction after almost three years. Picture: Lyndon Mechielsen

Leading cancer surgeons have warned that delaying surgery deemed of lower urgency due to Covid-19 is likely to reduce survival rates and lead to life-threatening complications, as elective surgery suspensions in NSW and Victoria show no signs of lifting.

Doctors are especially concerned about prostate cancers, thyroid cancers and benign brain tumours, all of which often are not given urgent category 1 or category 2 status but can develop into more aggressive cancers or result in potentially fatal complications.

Payal Mukherjee, the chair of NSW state committee of the Royal Australian College of Surgeons said the pandemic meant such cancers were harder to monitor closely, with patients reluctant to visit doctors.

“There are some cancers that are not urgent. However, if they suddenly grow rapidly during the delay period, the patient’s outcome will be compromised. And that will directly influence their short-term and long-term survival,” Professor Mukherjee said.

Non-urgent elective surgery is suspended in NSW and Victoria, although NSW recently moved to reinstate day surgery procedures.

Breast cancer patients have also been hard hit by the suspensions, with some paying $50,000 to fund their own reconstructive surgery, according to the Breast Cancer Network of Australia.

A BCNA survey in 2018 found numerous patients believed they were on a waiting list for a reconstruction, despite being taken off.

“The system needs to be more transparent,” said BCNA chief executive Kirsten Pilatti.

For Cathy Kerr from Wollongong, who found out in March she had developed breast cancer for a second time, the postponement of elective surgeries was traumatic.

Initially she had a mastectomy and breast reconstruction scheduled for September 7. In August, she received a call from her surgeons advising her that due to Covid the hospital had re-evaluated her surgery and would only provide the mastectomy to the cancer-affected side, with plans to reconstruct her breasts later.

“After going through treatment for breast cancer and having the finish line in sight, I just found it all extremely traumatic,” she said. “You go from being ready to move to having the rug being pulled out from under you. It was just horrific. Absolutely horrific.”

Ms Kerr’s surgeons, Matthew Beck and Matthew Starr, initially appealed and secured a mastectomy and breast reconstruction – only for Wollongong Hospital to then change its decision.

For Ms Kerr, having to prolong her second battle with cancer was too mentally exhausting. She instead raised funds privately and had the surgery at Wollongong Private Hospital, a procedure that cost about $50,000.

“I could not come to terms with the alternative but I also didn’t want to die. It felt cruel, like we were back in the dark allowing a woman to have one breast removed and walk away,” she said.

Postponing elective surgeries has also traumatised Brisbane schoolteacher and mother of two Laura van Zyl. The 57-year-old was diagnosed with breast cancer in July, 2018. After a series of surgeries, ­including a lumpectomy, she was advised to have a mastectomy in 2018 and was told a breast reconstruction would take place the following year.

Instead, she has been wearing a prosthetic and awaiting reconstruction for nearly three years.

“My confusion is that I don’t understand why reconstruction surgery is considered elective because one doesn’t elect to get cancer. In my heart of hearts, the reconstruction is part of the cancer process,” she said.

Dr Beck said worrying research from the Breast Cancer ­Society had indicated a number of women had missed their screening during Covid and it was likely to lead to a worse outcome for ­doctors and patients in the not-so-distant future.