There are the “direct” deaths from the coronavirus. And there are - and there will be, unfortunately - the collateral victims of the Covid-19 epidemic. “Induced” deaths due to delays in cancer care, in particular. At the Léon Bérard oncology center which he directs in Lyon (Rhône), Professor Jean-Yves Blay already sees patients arriving with tumors larger than they should. So, whoever also heads the Unicancer federation alerts: there will be an excess of mortality from cancer. To mitigate it, he calls the sick to consult.
How many more cancer deaths should we fear?
JEAN-YVES BLAY. We fear 5,000 to 10,000 more cancer deaths. These figures are the optimistic hypothesis: the English have projections of up to 40,000 excess deceased patients. This problem is linked to the delay in treatment. Patients already followed continued to be timely. So the ones that worry us are the new patients. For example, women who, in March, felt a small lump in the breast and said that it was better to wait until the end of the epidemic to consult. In centers 100% dedicated to oncology, we note a decrease of 20 to 50% of new cases, so imagine in general hospitals ...
How do you do your calculation?
There are 380,000 (diagnosed) cancers per year, or about 30,000 per month for which almost half of the patients did not consult during confinement. The question is: for them, what is the impact of this delay in terms of survival? The figures vary, but we know that a month late loses between 5% and 20% of chances depending on the tumors. Prostate cancer is often fairly painless at first, two months probably doesn't make much difference. But for breasts, ovaries or sarcomas, the risk of relapse and mortality is increased from the first diagnostic delays.
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Have you seen patients yourself in this case?
Yes, many. I think of this very young patient who thought that her little ganglion above her collarbone could have waited for the end of the Covid. We have just taken care of her for Hodgkin lymphoma. Lots of people waited. However, having a tumor of one or five centimeters is not the same thing. It becomes a big thing, when it should not have been. I don't like to be a catastrophist, but this trend is the same in all countries. We must alert and act to limit the damage.
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How? 'Or' What ?
Saying: come and consult! Appointments resume but there is no patient tsunami. This means that those who have not been there since March do not rush into our doors. The number of colonoscopies to detect colon cancer has dropped by 80%. We're going to have a time lag. The only thing we want is for the sick to come back for treatment.
The Asco World Cancer Congress has just ended in the United States. What Covid-related data was presented there?
We already know that cured patients have no more risk than the general population. This is good news. A study confirms, however, the danger of a coronavirus infection for patients in the advanced phase of treatment. Their 30-day mortality is around 20 to 30%. For lung cancer, it is 34.6%.
So they have to be extra careful?
Of course. But it is also by dint of hearing this that people did not come to our hospitals. It is exactly like in flu season: it is necessary to protect the most fragile patients. At the hospital, we are used to this!
