What's worse than cancer

Warn oncologists : Cancer is more deadly than corona infections

Let's say someone feels weak overall, has lost some weight recently, he or she sweats in an uncomfortable way quite often at night. And the stool may also look strangely black. In normal times, this person would now go to the doctor with what the doctor calls “unclear symptoms”. But nothing is normal at the moment: In times of the Covid-19 pandemic, most people don't even go to the doctor. But that could have serious consequences - for example, if these are the first symptoms of cancer.

It's not like that there is less cancer

"We are worried because the number of patients presented with new cases in early curable tumor stages has fallen sharply in the last few weeks," says Ulrich Keilholz, Head of the Comprehensive Cancer Center (CCCC) at the Charité. “Because it is not the case that less cancer develops. We fear that in a few weeks to months we will see more patients with tumors in advanced stages. For a number of types of cancer, this would mean more intensive therapy and a lower cure rate, ”says Keilholz.

Practices must adhere to strict rules

On the one hand, patients with unclear symptoms would simply avoid going to the doctor; on the other hand, early diagnosis, i.e. the normal chain of examinations involving general practitioners and specialists, does not work normally. For example, fewer appointments would be available, for example with resident radiologists. After all, the practices have to adhere to strict hygiene and distance rules, through which significantly fewer patients can come. But he doesn't know exactly what the problem is.

20 percent fewer patients per day

"Diagnostics are limited here too, of course," says Keilholz. The hygiene requirements have also increased significantly at the Charité. There are fewer appointments. The disinfection takes longer. Distance regulations meant less space in the waiting rooms. They can examine about 20 percent fewer patients per day. However, this only applies to computer tomographies and X-rays, the laboratory work runs normally.

Keilholz estimates that around 30 percent fewer new patients would come to the Charité's Comprehensive Cancer Center. In the case of breast cancer, it is even 50 percent less, since the breast cancer screenings were suspended, through which many women become aware of the disease. "Even with colon cancer it is around 50 percent," says Keilholz. He suspects that patients do not have a colonoscopy because they also carry a risk of infection. Early treatment is still important for a good chance of recovery. "For gastric cancer, therapy should start within four weeks, for colon cancer you have around six to eight weeks, with breast cancer, however, it varies greatly from person to person."

People don't let symptoms clear up

A “task force”, which the German Cancer Research Center (DKFZ), the German Cancer Aid and the German Cancer Society had set up in mid-March as a joint early warning system to identify changes in oncological care during the Covid-19, is also warning of a “bug wave of cancer cases diagnosed too late”. 19 pandemic to watch. "Suspending early detection and clarification measures can only be tolerated for a short period of time, otherwise tumors may only be detected at an advanced stage with a worse prognosis," says Michael Baumann, CEO of the German Cancer Research Center. “We are currently observing that people do not have their symptoms clarified by a doctor. However, patients should not be afraid to visit doctors and hospitals even during the Covid-19 pandemic. "

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"We also recommend coordinating the capacities for diagnosing and treating cancer in the regional area through control centers, which are ideally attached to the large cancer centers," says Olaf Ortmann, President of the German Cancer Society. "Patients could then reach the control centers via special hotlines." But that does not seem to work quite as usual: "It is astonishing that our hotline is receiving significantly fewer inquiries at the moment," says Ulrich Keilholz. He wonders why this is: "Maybe that's because the results don't reach the doctor together and the diagnostics don't go as they should."

The telephones run hot on some hotlines

At other cancer information hotlines, however, the phones have been running hot since the beginning of the pandemic: Susanne Weg-Remers, head of the KID cancer information service at the German Cancer Research Center, speaks of a flood of inquiries at the beginning of the pandemic. Otherwise they would have around 2,700 inquiries per month, in March there were 4,200, 38 percent of which were about Covid-19. In April it died down a bit. Weg-Remers suspects that the fact that there were fewer inquiries in April could also be a consequence of people not going to the doctor. Fewer cancer diagnoses would result in less need for information, but that is only speculation. “We offer a very low-threshold offer. You can call us spontaneously, that's a different situation than at the doctor's, where you initially only speak to an office assistant. "

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The German Cancer Aid hotline has also been busy for weeks with questions that cancer patients are asking themselves due to the pandemic situation: "At first it was mainly about postponed tumor operations and diagnoses, about half of all calls related to the Covid-19 pandemic", says Christiana Tschoepe from the German Cancer Aid. “But now it's more in the direction of psycho-oncology.” And there are tragic cases: A 26-year-old man called from a hospital, for example. He had just been diagnosed with "advanced colon cancer" during a doctor's visit. The relatives were not allowed to visit him, let alone be present at the doctor's consultation. When he called the hotline, he looked helpless and in a state of shock. He had a lot of questions that he couldn't ask anyone: "Do I have to die now?" He asked.

Accompanying bans are a big issue

The topic of accompaniment is now a big one in the calls to the German Cancer Aid when there are bans on visiting and accompanying people. "Otherwise patients often take someone with them, and now the patients have to go to such discussions on their own," says Tschoepe. “And children say: 'We don't find out how our elderly parents are doing, who often cannot correctly reproduce a diagnosis on the phone. Otherwise, such questions can be asked directly at the doctor's consultation.” Solutions have to be found. "Why doesn't the doctor take the patient and her husband outside with him or ensure that a relative can at least be there virtually via tablet?"

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There were only a few calls from people who were afraid of being infected during an examination. "The good news is that mammography screening, which was suspended for weeks, will start again on May 4th," says Tschoepe. At first it was a great drama to get specialist appointments, now the situation is easing. The German Cancer Aid also appeals to patients to be examined: "It is much more important to clarify the cancer diagnosis than to protect yourself from corona," says Tschoepe.

Tumor operations were not suspended at the Charité

Ulrich Keilholz from the Charité sums it up: "More patients die from cancer than from corona infections." Tumor operations at the Charité - unlike in other German hospitals - have never been suspended. “But where we have been paying attention so far are the aftercare,” says Keilholz. “There is a risk of getting infected, which is why we postponed it as far as possible.” That is why there were hardly any follow-up appointments in the past six weeks. But it has been shown that the risk of infection is under control. Of several thousand cancer patients treated at the Charité, fewer than ten contracted a corona infection. "The risk of infecting other patients is very low," says Keilholz. Therefore one now wants to start the aftercare earlier again. “No problem arose in the six weeks, but if you were to skip it for three months, some could arise.” And so, cancer therapy is also moving more and more towards normality - even if only on a trial basis.

WHERE PATIENTS GET ADVICE:

The Cancer Information Service of the DKFZ (0800-420 30 40, krebsinformationsdienst @ dkfz.de) and that Cancer information network the German Cancer Aid (0800-80 70 88 77,

[email protected]) have provided additional information for cancer patients since the beginning of the Covid-19 pandemic. Both services have increased their capacities to cope with the current onslaught of demand, so there is now, for example additionally a chat room. The current opening times for the chat room can be found online at wwww.krebsinformationsdienst.de.

A lot of information on the subject can also be found on the Homepage of the Charité Comprehensive Cancer Center: https://cccc.charite.de. The center also offers one Cancer hotline for patients at the telephone number 030-450564222.

Psychological counseling (currently only by phone) is also offered by Berlin Cancer Society (www.berliner-krebsgesellschaft.de). Telephone appointments can be made on 030-283 24 00.

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