No single moment in medicine produces more anxiety for patients than surgery. As doctors, we work tirelessly to establish the invaluable trust needed so that patients feel comfortable undergoing what often sound like scary procedures.
The anxiety levels increase exponentially when patients are confronted with the dual concerns of cancer and Covid-19. It’s true that when the pandemic arrived in New York a few months ago, public health officials made the careful decision to cancel elective surgeries across the region, including some cancer procedures. At a time when our region was preparing for a surge in Covid-19 cases and didn’t have enough testing to determine the spread of the virus, it was important to take steps to preserve our ability to care for those critical cases and limit the number of people walking into hospitals.
A recent analysis of data from hospitals across the country showed that preventive cancer screenings have dropped between 86 and 94 percent due to the pandemic. But now it’s critical that patients feel confident to resume the care they need.
We still have a lot to learn about Covid-19 and how it will impact our country. But one thing we already know is how to safely provide surgery to patients who need it. And nowhere is that need greater than among patients battling cancer — which waits for no crisis or pandemic — because, for the vast majority of people who have the disease, it is a greater threat to their lives than the virus.
At Memorial Sloan Kettering Cancer Center, where I work, we did not make the decision to postpone cancer surgeries lightly. Our surgeons assessed which patients needed surgery right away, who could postpone it without negatively impacting their well-being, and whether other treatments like chemotherapy or radiation might give equivalent results. Some cancer surgeries can be postponed safely for up to a few months, but studies suggest that it’s not safe to wait longer than that, because a cancer that’s curable might progress and become incurable. At MSK we never stopped performing essential surgeries, though we did postpone some cases for which it was safe to do so.
As Covid-19 hospitalizations continue to fall across the region, all types of life-saving cancer surgeries have been occurring for several months, and patients who had to abruptly postpone their surgeries are getting the care they need.
At many hospitals around the metropolitan area, all patients are tested for Covid-19 before a hospitalization or a surgery. At my hospital, any patient who needs to be hospitalized overnight is tested every 72 hours, regardless of their initial Covid-19 status, for any changes in their results. And in the event that patients are infected, surgeons — bolstered by infectious-disease experts — are well equipped to minimize patients’ risks and are prepared to manage problems that may be virus-related. Evidence from our own institution suggests that the majority of patients who develop the virus within 30 days of a major surgical procedure do well and can usually recover as outpatients.
The test detects the virus in people who are ill as well as those who are infected but do not have symptoms. Hospitals like mine are doing this extensive testing to help us avoid the risk of operating on someone who feels well but may then develop Covid-19-related symptoms after surgery. Surgeries for patients with the virus are done in a separate operating room, and we have isolation procedures in place so that they are never in contact with non-Covid patients.
To protect against the virus, hospitals know we have to test more than just patients. We’re also tracking the health of our staff before they come to work, and test them as needed. For those who interact directly with patients, we perform weekly testing, and only those who test negative are allowed to report to work.
Following state regulations, many hospitals are limiting visitors, but they’re using technology to keep patients connected with their loved ones. At MSK, we’re providing tablets and smartphones to people who don’t have devices to help facilitate those virtual connections while they’re receiving care.
In many ways, a hospital is one of the cleanest, safest places a vulnerable patient can be right now. I urge any New Yorker who may be afraid to get the care you need to call your doctor. Your life could depend on it.
Dr. Jeffrey Drebin is chair of the Department of Surgery at Memorial Sloan Kettering Cancer Center, and specializes in treating cancers of the pancreas and liver.