The disease is silent but the impact every year is enormous, on patients, families, the country. About 50 thousand Portuguese are diagnosed with cancer per year and the disease is the second leading cause of death in the country – in 2018, the last year with available data, it was the cause of death for 28 451 Portuguese, 77 deaths every day. Today marks the World Day Against Cancer and the balance of the impact of the pandemic on the response to cancer patients in Portugal is yet to be done – the president of the Portuguese Society of Oncology estimated in a recent interview to Nascer do SOL that they may have stayed for diagnosing at least a thousand patients in 2020, with more late diagnoses reaching consultations – which in the medium and long term can translate into drops in survival rates. The available information confirms a drop in activity in public hospitals, which treat the majority of patients. Screenings were also halted in 2020 for some months and in some cases all year round and the lesser difficulty in accessing family doctors is pointed out as another barrier to access, which in any area of health is linked to results.
Fewer operations, less referral patients A balance now closed at the Ministry of Health’s Transparency Portal concerns surgical activity in public hospitals. It is just one side of the activity in the 49 hospitals and public hospital centers. The data updated this week, which I analyzed, reveals that in 2020 there were 115 775 less surgeries scheduled in hospitals compared to 2019, a drop of almost 20%. The data do not discriminate the type of surgery and do not allow to understand yet what was the evolution in cancer surgery, an analysis that has not yet been made available and that every year shows patients operated beyond the recommended deadlines, but the fall is transversal and also the IPOs operated fewer patients in the past year, with falls between 5% and 20%. In 2019 the three IPO’s performed 24 042 thousand surgeries, scheduled and urgent, and last year there were 20 977.
The biggest break happened in the Porto IPO – in 2019, 12 576 patients were operated and in 2020, 10490. In the Lisbon IPO, there were 5365 scheduled operations, 10.7% less than in 2019, and also less urgent surgery. In the IPO of Coimbra, a smaller drop: 4413 scheduled surgeries were performed, a drop of 5%.
The figures reflect a year in which all hospitals had to adapt routines and there were breaks in referrals for consultations and surgery – which reduce the number of patients to be operated and will soon give the illusion of fewer patients waiting. At the same time, in the first wave as now, more situations of infected, isolated and quarantined professionals disturb the response capacity of the services.
At the Lisbon IPO, the year ended with an 8.9% drop in the number of new patients, he told io hospital. In 2019, 18 154 patients had been referred to the institute and last year there were 16 540. João Oliveira, president of the Lisbon IPO, explains to i that the biggest fall was in patients with requests for consultation made by health centers (-22 % compared to 2019), counterbalanced by smaller breaks in patients who went to the IPO by their own feet or requests received by the institute’s referral office. In the end, however, they ended up following more patients than in the previous year, which means that they had more patients – and that reality has also been that of the last few weeks, when hospitals were forced to stop activity again surgical treatment, even priority, and some patients have been referred to the IPO. “It is a network work that already existed and to which we respond with increased activity. And what I have found in the IPO professionals is not to be behind the effort that others are making in their circumstances ”.
João Oliveira says that the pandemic, with the new routines that forced hospitals to screen positive patients and equipment, reduced the response speed by itself, but the effort was always to maintain activity and there were areas such as bone marrow transplantation where 2020 ended with an increase in activity compared to 2019: there was a record of 90 bone marrow transplants after 77 in 2020. On the other hand, there were less 10,000 first consultations, also a drop of 20%, although the number of consultations telemedicine has tripled, which has enabled patient follow-up.
As for global balances in the follow-up of cancer patients in the country, the doctor argues that they are expected to be negative, but conclusions can only be established later. “In terms of global activity, it was obvious that it was lower, especially in the area of diagnosis, not least because many cancer diagnoses are made around primary health care, clinics that do tests and general public hospitals that had to turn their activity around for covid-19. We have to hypothesize that the implication for cancer treatment outcomes is deleterious, but saying exactly which one requires more knowledge, more data and the times of these analyzes are never fast. The most urgent things I think have globally found an answer within the NHS. At least in the IPO, that’s what we found, not meaning that what was left behind didn’t need to be dealt with. ”
In the IPO of Porto, adding all the surgical activity, there is a reduction of 20% in 2020, says the chairman of the board of directors, Rui Henrique. It was greater in the first three months of the pandemic, when there was a partial closure of the central operating room, “motivated by quarantine and covid-19 disease in the surgical teams and the need to adapt the inpatient areas, which reduced the response capacity”, remember. As of June, the recovery began, but the year would still fall short of the previous year. And with regard to new patients, in the IPO in Porto the drop in referrals was even greater: referral patients decreased by 17% last year, with the most affected areas being breast and digestive pathology, “which in part will reflect the impact negative impact of the pandemic on screening programs (breast and colorectal cancers) ”. In terms of medical consultations, and in a universe of around 390,000 in 2020, the drop seen compared to 2019 was around 0.3%. And here, too, the year was not worse due to the reinforcement of teleconsultations. And because we tried to fight the fear of seeking health care. “As of June, the vast majority of consultations returned to the face-to-face modality, indicating that the patients of the Porto IPO did not feel afraid to go to the hospital”, reinforces, in writing, the person in charge, considering that, in general, the year it ended less badly than it seemed, but the past few weeks have again disrupted the entire system. ” The expectation is that in 2021 the number of patients diagnosed with cancer will increase, a situation for which we have to be prepared.”
Action plan needed The Portuguese League Against Cancer has outlined a more negative scenario. The most positive news, tells i Vítor Veloso, president of the Northern Regional Nucleus of the Portuguese League Against Cancer, arrived yesterday: the European Commission presented a European Plan to Fight Cancer, with targets and 4 billion euros of funds Europeans reserved for strategies in this area. Vítor Veloso warns that entry into the system is the main problem and this may remain invisible, while hospitals respond to what arrives. Now that the screenings are being recovered, the League has seen people who should have been screened a year ago. In the North alone, Vítor Veloso exemplifies, last year there were 200,000 women who were not screened and it is estimated that among all screenings, 600 potentially curable early cancers remained to be diagnosed. “ The balance can only be highly negative in relation to the cancer care that the State was able to provide and the plan that existed, they practically forgot that there were chronic patients. Doctors at health centers are diverted to administrative tasks and follow-up of covid, patients do not reach doctors and are unable to make their complaints and are not asked for the necessary tests for diagnosis. When diagnosed, referral ends up being too late. General hospitals are having more difficulties and patients without diagnosis at the outset do not go to the IPO ”, he summarizes.
For Vítor Veloso, an action plan is needed and criticizes the Government for not having structured it earlier. “We had a period in the summer of calm when this could have been taken care of and structured and nothing was done. 2020 was a horrible year for national, dramatic oncology. The gains that we had achieved with the screenings were lost. Hopefully, things will get better and a plan will emerge and that has to come from the Government, it is not possible to leave hospitals that are unable to raise patients across the country ”.
Will a Marshall plan be needed in this area? For João Oliveira, there were some governmental measures throughout the pandemic, such as the reinforcement of the remuneration of the additional activity and easier hiring of professionals, hitherto blocked, which were beneficial. And he considers that the challenge is to strengthen the NHS. “These are measures that, above all, I would like to see become intrinsic to the system and go beyond the pandemic. The Marshall plan allowed structural changes in many European countries, in industry, in economic recovery. I would like the SNS to be the same. May many of the exceptional measures we have taken because of the pandemic become definitive. ”