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The disease is silent but the impact every year is enormous, on patients, families, the country. Around 50,000 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 per day. Today marks World Cancer Day and the balance of the impact of the pandemic on the response to cancer patients in Portugal has not yet been done: the president of the Portuguese Oncology Society estimated in a recent interview with Nascer do SOL that may have stayed to diagnose at least a thousand patients in 2020, reaching the latest diagnostic consultations, which in the medium and long term can translate into decreases in survival rates. The available information confirms a decrease in activity in public hospitals, which treat the majority of patients. Screenings were also stopped in 2020 for a few months and in some cases throughout the year and the lower difficulty in accessing family doctors is pointed out as another barrier to access, which in any health field is linked to results.
In 2019, the three OPIs performed 24,042 thousand surgeries, scheduled and urgent, and last year there were 20,977
Fewer operations, fewer patients referred to hospitals
A balance now closed in the Transparency Portal of the Ministry of Health refers to surgical activity in public hospitals. It is only one side of the activity in the 49 hospitals and public hospitals. Updated data this week, which I analyzed, reveals that in 2020 there were 115,775 fewer surgeries scheduled in hospitals compared to 2019, a drop of nearly 20%. The data do not discriminate the type of surgery and do not yet allow us to understand what was the evolution in cancer surgery, an analysis that has not yet been made available and that each year shows patients operated beyond the recommended deadlines, but the fall It is cross-sectional and the IPOs also operated on fewer patients in the last year, with falls between 5% and 20%. In 2019, the three OPIs performed 24,042 thousand surgeries, scheduled and urgent, and last year there were 20,977.
The largest rupture occurred at the OPI in Porto: in 2019, 12,576 patients were operated and in 2020, 10,490. At the OPI in Lisbon, there were 5,365 operations scheduled, 10.7% less than in 2019, and also less urgent surgeries . At the Coimbra IPO, a minor drop: 4,413 scheduled surgeries were performed, a 5% drop.
The figures reflect a year in which all hospitals had to adapt routines and there were interruptions in referrals for consultations and surgery, which reduces the number of patients to be operated on 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 services.
At the Lisbon IPO, the year ended with an 8.9% drop in the number of new patients, he told the 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 OPI, explains that the greatest drop was in patients with requests for consultation made by health centers (- 22% compared to 2019), offset by small interruptions in patients who came to the OPI on 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 they had more patients – and that has also been the reality of recent weeks, when hospitals were forced to stop treatment activity again. surgical. even priority, and some patients have been referred to the OPI. “It is a networking that already existed and to which we respond more actively. And what I have found in the professionals of the IPO 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 patients and positive equipment, reduced the speed of response by itself, but the effort was always to maintain activity and there were areas such as transplantation of bone marrow where 2020 ended with an increase in activity compared to 2019: a record of 90 bone marrow transplants were registered after 77 in 2020. On the other hand, there were fewer 10,000 first visits, also a 20% drop, although the number of telemedicine consultations has tripled, allowing patient follow-up.
Regarding the global balances in the follow-up of cancer patients in the country, the doctor argues that they are expected to be negative, but the conclusions can only be established later. “In terms of global activity, it was obvious that it was less, especially in the area of diagnostics, among other things because many cancer diagnoses are made around primary health care, clinics that do tests and public hospitals in general. they had to convert their activity around covid-19. We have to hypothesize that the implication for cancer treatment outcomes is detrimental, but saying exactly which one requires more knowledge, more data, and the timing of these analyzes is never quick. I think the most urgent things have found an answer globally within the NHS. At least at the IPO, that’s what we found, not wanting to say that what was left behind didn’t need to be addressed. “
In the IPO of Porto, adding all the surgical activity, there is a reduction of 20% in 2020, says the first president of the board of directors, Rui Henrique. It was higher 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 hospitalization areas, which reduced the response capacity” , remember. Recovery began in June, but the year would still be below the previous year. And as for new patients, at the OPI in Porto the drop in referrals was even greater: referral patients decreased by 17% last year, the most affected areas being mammary and digestive pathology, “which in part will reflect the negative impact of the pandemic on screening programs (breast and colorectal cancer) ”. Regarding medical consultations, and in a universe of around 390,000 in 2020, the drop observed compared to 2019 is around 0.3%. And here the year was not worse either due to the reinforcement of teleconsultations. And because we try to combat the fear of seeking medical attention. “As of June, the vast majority of consultations were once again face-to-face, which indicates that OPI patients in Porto were not afraid to go to the hospital,” reinforces, in writing, the person in charge, considering that, in Overall, the year ended less badly than it seemed, but the last few weeks have turned the whole system upside down again. “The expectation is that in 2021 the number of patients diagnosed with cancer will increase, a situation for which we have to be prepared.”
2020 was a horrible year for national dramatic oncology. Vítor Veloso, Portuguese League Against Cancer
Action plan required
The Portuguese League Against Cancer has drawn a more negative scenario. The most positive news, says i Vítor Veloso, president of the Northern Regional Core of the Portuguese League Against Cancer, arrived yesterday: the European Commission presented a European Plan to Fight Cancer, with objectives and 4,000 million euros of European funds reserved for strategies in this area. Vítor Veloso warns that the entrance to the system is the main problem and this can remain invisible, while the hospitals respond to what arrives. Now that the screenings are picking up, 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 did not undergo screening and it is estimated that among all the screening tests, 600 potentially curable early cancers remained to be diagnosed. “The balance can only be very negative in relation to the oncological care that the State was able to provide and the plan that existed, they practically forgot that there were chronic patients. Doctors at the health center are diverted to administrative and covid monitoring tasks, patients do not reach doctors and cannot present their complaints and are not asked for the tests necessary for diagnosis. When diagnosed, the shunt comes too late. General hospitals are having more difficulties and patients without diagnosis at first do not go to the OPI ”, he summarizes.
For Vítor Veloso, an action plan is needed and he criticizes the Government for not having structured it before. “We had a lull in the summer where this could have been fixed and structured and nothing was done. 2020 was a horrible year for national dramatic oncology. The achievements that we had made with the projections were lost. Hopefully things improve and a plan emerges and that has to come from the Government, it is not possible to leave the hospitals that cannot raise patients throughout the country ”.
I would like the SNS to be the same. That many of the exceptional measures we have taken because of the pandemic are final. João Oliveira, President of the Lisbon IPO
Will a Marshall plan be needed in this area? For João Oliveira, there were some government measures throughout the pandemic, such as the reinforcement of the remuneration of the additional activity and the facilitation of the hiring of professionals, until now blocked, that were beneficial. And he sees the challenge as strengthening the NHS. “These are measures that, above all, I would like to be 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. That many of the exceptional measures we have taken due to the pandemic are definitive. “
