Jackie Manthorne is president and CEO of Canadian Cancer Survivor Network.
Cancer is already the leading cause of death in Canada, but it has now reached a new crisis point because of widespread disruptions of screening, treatment and surgeries prompted by the COVID-19 pandemic. Unless governments act quickly to deal with these backlogs, tens of thousands of Canadians who otherwise would have lived are expected to die from cancer by the end of this decade.
Simply returning to prepandemic levels of cancer screening and care won’t save these lives. An April study published in the International Journal of Cancer used simulation models to estimate that returning to how our systems were performing before the pandemic would still lead to 21,247 more cancer deaths in Canada between 2020 and 2030. That would represent a 2-per-cent increase in overall cancer deaths in Canada, with the highest increased mortality rates among the young and those with cancers that would otherwise have had a moderate-to-high survival rate.
Taken together, these additional deaths would rob each of these Canadians of an average of 16.7 years of life they would have had. Those under the age of 15 would on average die more than 50 years prematurely.
Clearly, returning to the status quo cannot be an option.
Fortunately, the same study predicts that more than four in five of these excess cancer deaths could be prevented if treatment capacity were increased by 10 per cent, to cope with current cases and clear the backlog.
But every day we delay doing this means more needless deaths. The study estimated that each four-week delay in cancer diagnosis increases the mortality rate by 6 per cent; meanwhile, research published in the BMJ found that every four-week delay in cancer treatment can increase mortality by six to 13 per cent. These increases are also cumulative, so the longer the delays, the higher the likelihood of premature death.
A July, 2020 survey of cancer patients and their caregivers found that half of cancer patients had their cancer care appointments cancelled, postponed or rescheduled in 2021. Sixty per cent of recently diagnosed patients and 70 per cent of patients with metastatic cancer reported similar delays. According to Dr. Anna Wilkinson, a family physician and assistant professor in the Department of Family Medicine at the University of Ottawa, there were 41 per cent fewer screening tests in Ontario for breast, lung, colon and cervical cancer in 2020 compared with 2019, while the number of diagnostic mammograms performed in Quebec decreased by 13 per cent between 2020 and 2021.
Experts say these delayed screenings mean more patients will be diagnosed with advanced stages of cancers that require more surgeries and aggressive treatments such as radiation therapy and chemotherapy. This in turn will add to the pressures on our healthcare system, particularly healthcare workers already under stress after more than two years of COVID-19, and increase the cost of cancer care.
Worse, these delayed diagnoses may not yet be apparent in our systems. Many of our loved ones may have cancer and be unaware of it, and are unable or unwilling to see to doctor owing to the lingering effects of the pandemic.
To be clear, our cancer care systems were struggling before. Now, the situation is even worse, and our strategies must evolve in response.
So while Canada’s provincial and territorial premiers will surely have a lot to discuss when they gather this week in Victoria for their annual summer meeting, it’s hugely important that addressing the cancer care crisis is high on their agenda.
They must start by acknowledging the extent of the problem and commit to increase cancer screening and treatment capacity by at least 10 per cent over prepandemic levels for at least three years. One way to help pay for this would be to use some of the recent Canada Health Transfer top-up that was earmarked for surgical backlogs to prioritize the cancer surgeries that have been delayed and have accumulated.
The premiers also need to develop new action plans for each of their provinces and territories. This is particularly urgent in Ontario, where nearly 9,000 more people could die from cancer by 2030 if screening and treatment capacity isn’t increased. The Ontario government should set up a multistakeholder advisory group, including diverse patient representatives, healthcare professionals and health equity experts, to renew its plan.
Canada’s federal, provincial and territorial health ministers also need to meet to discuss how to tackle the cancer crisis over the longer term. While each jurisdiction has its own unique set of issues facing its cancer care systems, a problem of this magnitude can only be addressed with coordinated, collective action.
Cancer hasn’t waited for the pandemic to end. We need action, now.
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