Cancer charities are warning that they expect to see a spike in cancer patient numbers this year as lockdown and COVID restrictions impacted the diagnosis and early treatment of the disease in 2020.
Representatives of various charitable organisations, as well as members of the medical profession, spoke on Thursday night at a forum to mark World Cancer Day. The focus of the event was ‘Cancer care during COVID-19′.
Speaking during a panel presentation at the event, Dr. Samantha Digby, a member of Cayman Islands Cancer Society board, told attendees that the charity is “fearful about what 2021 will bring.”
Janette Fitzgerald, chief administrator at the Cayman Islands Breast Cancer Foundation, said her foundation is already seeing more people approaching it for help.
“The number of people we’re seeing with breast cancer has rocketed,” she said. “We’re shocked by the amount who have come through our door in the last eight weeks alone.”
During the COVID-19 lockdown, between March and June last year, medical facilities were mostly seeing just emergency cases, as hospitals and health clinics tried to reduce the risk of coronavirus transmission to individuals with compromised immune systems.
While this approach may have prevented some of Cayman’s most vulnerable residents from contracting the virus, it had the inevitable effect of fewer people visiting their doctors for routine check-ups or wellness screenings where certain cancers may have diagnosed.
Fitzgerald said that since the last week of December, the Breast Cancer Foundation has seen about 20 new patients, which is more than double the number it would typically see in that timeframe. Of those, about half have late-stage cancers.
“Normally, we get people early on in the battle,” she said. “It’s been notable that in the last three months we’ve gotten more ladies that are in a later stage, or certainly further down the road than we would expect.”
Cayman probably has more oncologists and means of cancer treatments and diagnosis on island than ever before – a timely development considering, currently, no visiting specialists from overseas can travel to Cayman to work. Quarantine requirements in Cayman and the US also make travel for medical reasons difficult.
During lockdown, it was not possible to get mammograms done at local hospitals, Fitzgerald said. OceanMed healthcare facility was the only place where mammograms could be done at the time.
One complication involving patients under the care of doctors overseas, who could not travel to get follow-up scans, was that some doctors would not accept scans from hospitals or medical facilities with which they were not associated, she said.
Jennifer Weber, operations manager of the Cancer Society, told the Compass that the charity is also seeing increasing numbers of patients who need assistance – many of whom are Caymanians with no health insurance because they have lost their jobs.
She added that the Cancer Society, as well as helping out the patients monetarily when possible, has been referring them to other agencies that may be able to assist them financially, like the Needs Assessment Unit or the Department of Children and Family Services.
“Our numbers have increased,” she said, “and the people coming in to us for assistance has also changed. It’s skewed more to Caymanians now as a lot of the work permit holders had left the island. …
“We’re seeing every kind of cancer, from the blood cancers to breast cancer to prostate. Not only have we seen an increase in the number of patients with cancer, but because we have not been able to do the screenings, like pap smears and mammograms … we’re seeing people coming in with advanced cancer.”
One other, and continuing, effect of COVID restrictions on cancer patients, she said, is a rule that prevents those undergoing chemotherapy or immunotherapy treatments from being accompanied by a relative or friend during those therapies.
“That’s had a huge psychological and support impact on cancer patients,” she said. “Before, you could bring a loved one along with you, but during COVID and since COVID, no one except the patient is allowed in, and that takes a real toll on a patient, for example, who has been undergoing chemo for 18 months.”
Jasmine, a palliative and hospice care facility, has also been caring for cancer sufferers. Director of operations and nursing Felicia McLean said during the COVID lockdown, some patients were referred to Jasmine for symptom management after they were unable to undergo their treatments on island and had to be cared for before being able to leave island for therapy overseas. Radiation treatment is not available in Cayman, so anyone requiring it must travel overseas.
McLean said Jasmine also saw an increase in the number of patients being referred to it.
“I think, in July alone, we had our highest number of referrals, I can’t tell you exactly how many were cancer referrals, but it was high,” she told the forum audience on Thursday, adding that Jasmine is continuing to see rising numbers, including cancer patients who are returning to Cayman.
Screenings numbers returning to normal
Health Services Authority Medical Director Dr. Delroy Jefferson, speaking at the forum, said cancer screenings, especially for colonoscopy and prostate tests, at the HSA have now reached pre-COVID levels.
He urged any member of the public who has cancer concerns to get screened now, while there are no reports of COVID community transmission. “We don’t know what’s going to happen in the future, so now is the time to come in,” he said.
Oncologist Dr. Lundie Richards, who also spoke at the forum, encouraged cancer sufferers to get inoculated against the coronavirus.
“Every patient with cancer should consider being vaccinated,” he said, adding that the shots will prevent or minimise infection.
In his presentation, Richards outlined research which indicated that cancer patients most at risk of severe symptoms or death from COVID were elderly individuals, those with blood cancers like leukaemia, and those who are undergoing, or have recently undergone, chemotherapy.
During the lockdown period, the number of people who registered with the Cayman Islands Cancer Registry also fell off dramatically. Cancer Registrar Amanda Nicholson told the forum that in the three-month period from March, the only way people could register was via email or online “but not everyone has access to a computer”.
She added, “During those months, our registration numbers were very low.”
Nicholson told the Compass later that there was not a marked increase in registration right after lockdown.
“It took a few months before we returned to pre-COVID registration rates, but we are definitely back to where we were, thankfully,” she said. “I suspect that registration rates increased because those who couldn’t register during lockdown, chose to do so once they were able.
“I think one of the big reasons why rates increased is because, once it became safe, our partner agencies began to open their doors to patients/clients and were once again able to spread the word about the cancer registry.”
She is currently collating figures as there have been a lot of registrants in recent weeks, but said the total number of people on the register is between 550 and 600.
The most commonly reported cancers among males in Cayman, are: prostate (17%), cancers of the blood (13%), and lung cancer (12%), while the most commonly reported cancers among females are: breast (53%), colon (7%), and ovarian (5%).