COVID fears could impact Cayman’s cancer cases

Experts warn spike may be possible in coming months

Local cancer experts are projecting a potential spike in newly diagnosed, late-stage cancer cases amid concerns that people were reluctant to visit their doctors during the COVID lockdown.

The number of people who registered with the Cancer Registry between March and June this year – when the COVID lockdown was in force – was halved, compared to the same period last year, and the Cancer Society says it is seeing more people being diagnosed with late-stage cancers.

Dr. Lundie Richards, haematologist-oncologist at the Health Services Authority, said he believes Cayman could see a rise in the number of new cancer patients and an increase in the severity of the disease.

Cancer Society Operations Manager Jennifer Weber says she expects demands for assistance to increase in the coming months. Photo: Submitted

“I say that is possible, and what we may see coming up later on… [is] patients presenting with more advanced stage disease. Perhaps they would have been noticing something coming on earlier and, out of fear, maybe not sought medical attention,” Richards said.

Cayman Islands Cancer Society’s operations manager Jennifer Weber said she has already seen cases where patients delayed seeking medical attention due to COVID fears and ended up with advanced stage diagnoses.

“We would naturally find more early-stage cancers because we would be looking for them through the screening process. But we had to suspend those because our office has been closed. We weren’t seeing diagnoses that were sort of serendipitous because of a screening. Instead, we’ve been seeing really severe stage four cancers,” she told the Cayman Compass.

Weber said it’s only the people who are in the “worst possible situations” that are now coming forward after having avoided seeking treatment due to COVID concerns.

“They present at the hospital with severe stomach pain and end up getting diagnosed with stomach cancer. They present at the hospital with terrible pain in their lower abdomen – they ended up with colon cancer. Someone starts having trouble with their throat, swallowing, it’s throat cancer… the really difficult cases that would have probably presented anyway,” she said.

Richards said patients with breast or colon cancer typically would not come to him first – they would be diagnosed by a surgeon before being referred to him to determine complete cancer staging and treatment, so it is hard for him to quantify a projected figure for local cases.

Cancer Registrar Amanda Nicholson says she
has noted a 52% drop in registrations over the
COVID period. – Photo: Reshma Ragoonath

Cancer Registrar Amanda Nicholson said the Cancer Registry has seen a 52% drop in registrations between March and June this year, compared to the same period last year. “From March-June of 2019, we had 27 new registrations. During the same period in 2020, we had 13,” she said.

“I think it’ll be interesting to see, going forward, if maybe we see a sudden spike in cancer cases because folks hadn’t been going to the doctor previously,” she said.

“I guess we’ll find that out shortly, and I know that a lot of medical facilities, not just here, but everywhere, all over, were only doing face-to-face consultations if absolutely necessary.”

Nicholson believes that drop is a result of people not being able to register due to the restrictions imposed by government and self-imposed restrictions by cancer patients. She said people did not come into the registry during the curfew and shelter-in-place measures, and also the registry was trying to minimise person-to-person contact.

“The one way that we were accepting registrations was through email, but that means that the registrar would have to have access to a printer and a scanner and not everybody [has access]. So, we have seen registration rates drop during the last few months, but it’s my hope that as things slowly go back to normal, we’re going to see those increase. For now, we’re just kind of waiting to see how things get back on track,” she said.

Approximately 500 people are logged in the Cancer Registry database – 67% of whom are female and 33% are male.

Fear of COVID raised risk for patients

Dr. Lundie Richards, haematologist-oncologist at
the Health Services Authority says cancer patients’ treatments continued through the COVID lockdown. Photo: HSA

Richards said that during the lockdown period, cancer patients continued their treatments at the HSA under strict conditions to ensure their safety and to guard against them contracting COVID-19.

“During that lockdown, patients whom we needed to see would come directly to the hospital. They would have a pass and maintained the physical, social distancing. So, they themselves did an enormous thing in terms of prevention and the whole aspect of hand hygiene and using a mask. I think most people across the society have been very good in following these,” he said.

In fact, Richards said, Cayman as a community has followed the health protocols, and that has created a safety net for cancer patients and those with compromised immune systems.

“It does provide us with some comfort that most of our patients will have weathered this pandemic without much complication, notwithstanding, I know, that we are going to have people who will have progressive disease, either because they may have contracted COVID or because for some reason they may have fallen through the cracks because they didn’t turn up,” he said.

Richards said that during the COVID restriction period, patients did undergo their required cancer treatments, but some opted out of check-ups out of fear of exposure to the virus.

“Some patients have actually self-deferred,” he said. In some cases, after reviewing their docket, he said patients’ appointments were also rescheduled to reduce their risk.

Job loss increases demand for support

When Cayman’s borders closed, many workers, especially those in the tourism and hospitality industries, ended up on the breadline, and that included cancer patients and their families.

Weber said the Cancer Society is already feeling the additional demand from that change in circumstance for its clients.

“Cancer is never easy for anyone, but it just gets exponentially harder when you factor in other things, like the fact that people don’t have much income stability, or… that now they don’t have any income. And then you factor in that they have low-level insurance, and then they don’t have any insurance. It just gets harder and harder for people,” she said.

She said the demand for assistance from the Cancer Society has grown over the years and she expects that to continue as those who are now unemployed run out of money or health insurance.

“I think what’s going to happen is it’s going to continue to be difficult for people because, under normal circumstances before this pandemic, it wasn’t like everybody was saying, ‘Wow, everything’s great. We have everything we need and there’s no unemployment or there’s no difficulty.’ People were already having a hard time, so this has exacerbated the problem for sure,” she said.

Weber said those assisting cancer patients will continue to work to help impacted patients and their families.

The Cancer Society provides vouchers that cover the cost of screenings for a variety of cancers for clients that cannot otherwise afford them.

“When they start to reopen again and we start our vouchers, I think we’ll see a flood of people who [will] come in and start getting those screenings. And then it’ll probably be a couple of months of lag time before we start seeing those early cancer or pre-cancerous or stage one cancers starting,” she said.

500 – Approximate number of people registered with the Cancer Registry. Of those, 67% are female and 33% are male.

Most commonly reported cancers
FOR MEN
1) Prostate
2) Cancers of the blood
3) Lung
FOR WOMEN
1) Breast*
2) Colon
3) Ovarian
*Breast cancer remains the most reported cancer overall, comprising 36% of all cases.
– Source: Cancer Registry

Further Reading: Cayman Health

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