Delayed treatment will put pressure on health care system

Heart health, cancer cases and stroke prognosis worse due to patients skipping care

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Delayed care for major health conditions in 2020 is leading specialists through the Denver metro area to worry that it could take more than a decade to recover from the emotional, financial and societal price.

According to a study from the Centers for Disease Control and Prevention (CDC), medical care delay in 2020 contributed to increased morbidity and mortality risks associated with treatable and preventable health conditions.

Cancer cases are increasing, long-term treatment for heart issues has become more complicated, mental health and general health care lost a year and doctors are working to clear a backlog in all areas.

Cancer cases rising

Dr. Radhika Acharya-Leon, section chief for medical oncology at Highlands Ranch Hospital, said the consequences of delayed treatment are starting to emerge each day where the disease is more progressed in colon, breast, prostate and lung cancer cases.

“The more people delayed screenings and follow-up testing, the more the prognosis is going to change,” she said. “The longer treatment is delayed, the more your rate of survival decreases. Patients we are seeing now have a worse outlook.”

According to the American Journal of Managed Care, screenings for breast, colon, prostate and lung cancer dropped dramatically in 2020. At the peak of the COVID-19 pandemic, breast cancer screenings dropped 85%, colonoscopies dropped by 75%, lung cancer screenings were down 56%, and prostate testing decreased by 74%.

By delaying screenings, and ignoring symptoms, Acharya-Leon said education about the importance of early diagnosis and intervention went out the window in 2020.

Another concerning trend was patients skipping follow-up care. Acharya-Leon said it is vital for patients who were treated for cancer in the past to follow up to make sure the disease has not returned. When those patients are coming back, the prognosis is not good.

“The fallout from this is going to be a decade at least,” she said. “We have a situation in this country where you go from having a curable situation to an incurable situation. The cost to society is going to be huge.”

Dr. Lisa Wynn, of CU Medicine Obstetrics and Gynecology in Highlands Ranch, said it has been difficult talking to patients who put off care and are now receiving bad news.

Wynn said she had a patient who put off getting a recommended mammogram in 2018. She then skipped doing it 2019 and could not do it in 2020. In 2021, she has been diagnosed with breast cancer.

“We are doing a lot to get patients caught up,” Wynn said. “We are even doing walk-in mammograms. We are set up to do everything in one day. We are doing your blood work, mammograms, and pap smear in this building. One day, all done.”

Heart health

Dr. Nick Tsipis, the associate medical director at Swedish Medical Center in Englewood, said the emergency room had some alarming trends in 2020 that will take years to sort out. One of those trends was delaying care for a heart attack.

“The initial recommendations were to avoid hospitals,” Tsipis said. “While well intentioned, now we know it should have been worded differently. We saw patients who had had a heart attack that happened more than 24 hours before. These patients knew something was not right but wanted to wait. They did not want to burden the system.”

According to the American Heart Association, heart disease remains the leading cause of death in the world with 86 million deaths and more than 523 million cases diagnosed a year. In 2020, the American College of Cardiology reported a drop in common heart attacks presenting in emergency rooms by 38%.

“COVID started as this strange phenomenon. We actually started wondering where all the heart attacks went,” said Interventional Cardiologist Anthony Cedrone, of South Denver Cardiology Associates. “In reality, they did not go to the hospital to get an official diagnosis. The heart attacks are still there, it is just much worse.”

The experts at South Denver Cardiology Associates, with offices in Littleton, Englewood, Castle Rock and Parker, have seen the fallout from delayed care. Cedrone said when he sees patients who were treated late for a heart attack, they still devise a treatment plan, working to preserve as much tissue as possible.

“It is plain and simple — the fear of COVID has led to more cardiac death this year,” Cedrone said. “It’s important to be less scared of COVID, pay attention to symptoms and go get treatment.”

Dr. Larry Allen, an advanced heart failure and transplant cardiologist with UCHealth University of Colorado Hospital, said they saw a 40% decrease in heart patients at the peak of the pandemic.

“When (patients) stay home with cardiac disease, there is permanent damage.” Allen said. “By the time we saw them, the damage was so much worse than it could have been and so much harder for us to treat.”

Allen said the current trends are frustrating because it took decades to teach the public about the symptoms of a heart attack and the importance of seeking emergency treatment.

In cases that did not lead to death, Allen said the cost to the health-care system will carry on for years.

Strokes

Brandon Pope, neuroscience chief at UCHealth Neuroscience Center, said there is a common saying for someone suffering from a stroke, “time is brain.” A stroke victim can lose up to two million neurons every minute they do not seek treatment, he said.

In 2020, Pope said doctors specializing in treating strokes across the Denver metro area saw a decrease in patients. Patients did not go to emergency rooms, and they skipped follow-up treatment way too often through the last year, he said.

Every hour without treatment equals about 3.6 years off their life expectancy, Pope said.

“No treatment means you are potentially aging your brain by years,” he said. “Over the last year, we saw patients coming in 24 hours or more after a stroke started. The longer the wait goes on, we can’t stress enough, the more brain you are losing.”

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