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COVID-19’s Impact on Cancer in South Africa

27 September 2021

With at least 60% of its annual severe illness claims linked to cancer, Sanlam says COVID-19 has added another layer of complexity, as lockdown periods have seen people delay crucial cancer screenings and surgical interventions.

The resultant failure to detect early-stage onset may present significant ramifications for many people’s treatment outcomes for years to come, says Dr Marion Morkel, Sanlam’s Chief Medical Officer.

The Impact of COVID-19 on Cancer Patients and Their Families

Dr Morkel says the group is seeing interrupted screening services in private and public facilities. “Most oncologists believe the true effects of interrupted screenings during a pandemic only become obvious up to five years later, when the slow-growing cancers are picked up. A big concern is that women aren’t having cervical pap smears, which indicate early cervical cancer.”

Insights From a Hospital

Dr Zainab Mohamed, Head: Clinical Unit Radiation Oncology at Groote Schuur Hospital, says the hospital saw a +20% reduction in new cancer patients at its unit in 2020. This trend has continued into 2021 and aligns with findings from overseas. The cause is multi-layered, stemming from people’s fear of contracting COVID-19 to less access to primary and secondary-level care amidst the major waves.

She adds that some ramifications are already evident, “We are already seeing many cases where patients have waited a long time to seek medical help and present with advanced disease. Delay in cancer surgeries and investigations due to the backlog is also being seen. Modelling studies done in other countries predict a higher number of cancer deaths over the next few years. Without vaccinations, we will see successive ‘waves’ of new and more virulent variants affecting health services and leading to longer delays in cancer diagnosis and treatment.”

The third wave has seen more patients present with severe COVID-19, which has led to Groote Schuur needing to ramp up its ICU beds faster than in the first and second waves. This has had big implications for cancer treatments, “Specialist clinic closures, along with reduced follow-up visits, and less access to special investigations and cancer surgeries have occurred due to staff redeployment to COVID-19 services – or testing positive or having to isolate.

“We try to catch up during periods of lower COVID-19 numbers, but we have limited capacity to do this, due to finite staff and hospital bed numbers, theatre lists and other resource constraints. Staff fatigue and burnout are also challenging. We may see the fallout from the pandemic for many years to come.”

Insights From CANSA

Zodwa Sithole, Head of Advocacy at the Cancer Association of South Africa (CANSA), says CANSA saw a countrywide drop in client bookings at its screening clinics, especially during peak infection rates. She adds that the country’s oncology services were stretched even prior to the pandemic, “Existing services are overwhelmed by the annually increasing numbers of cancer patients.

“Now, some oncology services have been scaled down. Timeous, lifesaving surgical, chemotherapy, radiation and palliative oncology treatments for adults and children are essential. These cannot be displaced by measures adopted to deal with COVID-19.”

She noted other impacts such as:

  • Delayed chemotherapy and radiation, which has severe implications for disease progression and a patient’s prognosis
  • Transport issues during level five, with patients needing letters to get to appointments – some were turned back
  • Loved ones not being able to be with patients at their appointments, which sometimes led to confusion and serious stress for families
  • Limited capacity at clinics, delaying screening and treatments
  • Broken machinery at certain hospitals delaying treatments, due to stalled repairs
  • Patients being turned back from hospitals with COVID-19 outbreaks due to being too ‘high-risk’
  • Delayed surgeries causing extreme anxiety for patients, who worried about the danger of the cancer spreading
  • Huge emotional distress for terminally ill patients in hospitals and their families when face-to-face visits were not allowed

Are Things Returning to Normal Now?

Sithole says screening requests have yet to return to pre-COVID-19 numbers. She says more research is needed to show the South African landscape of concerns regarding COVID-19’s long-term impact on cancer.

She stresses that cancer cases will continue to climb unless there’s greater availability of testing equipment for early detection; more accessibility to cancer services (surgeries, chemotherapy and radiation therapy) in all areas, including remote regions; and improved training of healthcare workers on different cancers.

On the Subject of Vaccinations

Another devastating impact of COVID-19 is that many cancer patients are having to isolate in a far more restricted bubble because their immune system is so low. This has huge ramifications for palliative patients who have limited time, but now can’t really leave the house.

Dr Mohamed urges all cancer patients to be vaccinated if they can. “Patients with advanced cancer who are still mobile should consider being vaccinated if given the go-ahead. However, those who are very frail and bedbound due to their cancer should be protected by their loved ones choosing to be vaccinated.”

Dr Morkel said that there may be a silver lining from the quick rollout of the COVID-19 vaccinations. “Perhaps the iterative model adopted in the race to develop a COVID-19 vaccination could make vaccination development for other diseases such as HIV and certain cancers faster as well. We can take learnings from the mRNA approach, with its targeted treatment, which has few side effects and is easily accepted by the body,” concludes Dr Morkel.

To access CANSA’s support, use their WhatsApp line (071 867 3580) or tele counselling service. To donate to CANSA, visit their online support platforms.

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