When Covid-19 forces you to deprogram some heavy oncological operations

The announcement had the effect of a “blow to the head”. The operation that Jean-Pierre, 73, had to undergo on October 28 consisted in the removal of part of his esophagus. The seventy-year-old, being treated at the Léon Bérard cancer center in Lyon for a carcinoma following a melanoma, had learned a few days earlier that this operation would be deprogrammed.

“I accepted the idea of ​​undergoing such an operation,” he says without bitterness. I was really prepared. I was fine in my head. I even got hooked on sports to be physically ready to take the shock ”. But the decision to deprogram the operations came to reshuffle the cards. And temporarily floods his “eternal optimism”. “I blamed the blow,” he confesses.

To cope with the massive influx of coronavirus patients and free up beds in intensive care units, the ARS (regional health agency) has asked hospitals to postpone surgeries deemed non-urgent. Result: the HCL (Civil Hospitals of Lyon) postponed 62% of the interventions. The watchword, however, is not to deprogram everything related to oncology to avoid falling behind in patient care. We only postpone interventions that can be ”, we explain to the HCL.

Sometimes heavy surgeries are deprogrammed

The same slogan for Léon Bérard. “We do our best not to deprogram everything. Cancer requires quick treatment. The goal is not to lose any chance for patients ”, confirms Olivier Tredan, head of the medical oncology department. However, there are some exceptions, even in cancerology. The CLB had to perform some deprogramming in the margins. That is a dozen interventions. There are so-called functional surgeries that can be reprogrammed such as breast reconstructions. And “very heavy” interventions like the one that Jean-Pierre had to undergo.

“These are operations that require you to spend several days in intensive care after surgery. We are forced to postpone them because our pulley services are already 150% saturated ”, explains Olivier Tredan. “In these cases, it is necessary to modify the patient’s protocol. Deprogramming is not neutral, specifies Dr. Jean-Pierre Martin, oncologist and president of the League against cancer in the Rhône. We thus deviate from the therapeutic program we had decided on. We turn our necks to science and the patient risks doubting ”.

“If we wait a few more months, we cannot exclude that this may worsen the patient’s case”

Jean-Pierre’s operation was rescheduled for the end of November. “In the meantime, the oncologist was very responsive. In the days following this deprogramming it was decided to restart the chemo sessions to stop the progression of the cancer cells. Otherwise there is the risk that it will become unusable… ”, he testifies. And to continue: “I’m not sure if the chemo, of which I have already been able to verify the numerous side effects, is enough to stop the development of the disease. And I fear that this new date cannot be respected but I remain determined to fight ”.

What is the impact of these postponements from a medical point of view? “It’s hard to predict, replies Jean-Pierre Martin. A few weeks’ reschedule can be handled. If we wait a few more months, we cannot exclude that this may worsen the patient’s case even if he will remain on the sidelines. Mentally, however, it is something else. You won’t be able to stop people from wondering if things aren’t going as planned. It is something that can be experienced as a profound injustice ”.

“In the case of very aggressive tumors, there is no zero risk. We cannot exclude that the tumor will progress or metastasize if we postpone the scheduled surgery for a few months. This is why every decision is made with full knowledge of the facts and why the most invasive cancer interventions are generally not deprogrammed ”, also stresses Olivier Tredan, anxious to guarantee the best possible care for his patients. .

“One of the problems is after Covid”, warns Dr. Martin, fearing that “the real crisis is for tomorrow”. “We will have to adapt and organize to catch up with all the operations that have been deprogrammed since the spring, so as not to accentuate the delay in patient care,” he says, calling for the “redefinition of” specific places to put everything in place. ” “Hospitals that could be dedicated to this purpose should be accessible to all,” he concludes.