In this feature, we hear from Fazila Seker, Ph.D., the CEO and co-founder of MOLLI Surgical. She explains how new technology might help reduce surgical backlogs that have built up during the COVID-19 pandemic.
COVID-19 has forced entire industries to adapt to the challenges of the pandemic to ensure people’s needs can still be met.
Schools and educators have shifted curricula online to continue classes. Working from home has become the norm for many people, and clients have maintained their connections with companies virtually. The food service industry has pivoted from in-person dining to takeaway and delivery to continue serving their customers.
Unlike those other sectors, however, hospitals and clinics have not had the luxury of being able to pivot away from the way they deliver core services, apart from some adoption of telemedicine.
Their most vital services remain in-person, so they have taken significant steps not only to ensure patients’ safety but to reassure them as well.
Healthcare during a pandemic
To facilitate this, organizations such as the Centers for Disease Control and Prevention (CDC) and the Public Health Agency of Canada have outlined careful measures to minimize the risk of infection and keep patients, staff, and healthcare workers safe.
As a best practice, entries and access points have been limited in an attempt — one that is not always successful — to deter overcrowding and ensure physical distancing is possible.
The time allotted for appointments and procedures has been extended to allow equipment and areas to be thoroughly cleaned and disinfected after use.
Better workflows and scheduling have been enacted. Staff, nurses, and doctors are kept up to date with the most recent information regarding best practices in safety and treatment options.
The most urgent surgeries and procedures have been prioritized. Additional personal protective equipment, face masks, and transparent physical barriers have been used to limit personal contact.
These extensive safety measures demonstrate not only hospitals’ and administrators’ commitment to keeping patients as safe as possible during the pandemic, but also the recognition that beyond the risk of COVID-19, their lifesaving services are required for various procedures, evaluations, and emergencies.
However, hospitals’ revised protocols have also had unintended effects. Efforts to deter overcrowding have lowered the number of patients seen.
The reallocation of personnel and resources toward COVID-19 care has delayed the identification and treatment of new cancers.
The backlog challenge
Even before the pandemic, people were faced with inconsistent recommendations about the necessity of breast cancer screenings for given age groups, which differed by organization and area.
This conflicting information may lead people to misunderstand the necessity of regular screenings. In addition, misinformation surrounding COVID-19 and anxiety related to the risk of infection at the hospital or during transportation have led to people refusing procedures.
The inability to provide screenings has created a significant backlog from which hospitals are continuing to attempt to recover.
A recent report showed that a 2-month stop in mammographic screenings resulted in an increase in node-positive and stage 3 breast cancer.
Some studies have shown that it could take approximately 22 weeks to clear the backlog in screenings in a best-case scenario. In the worst-case scenario, it could continue to grow, further delaying patient diagnoses.
Surgical delays of 12 weeks for patients with breast cancer could lead to an estimated 6,100 excess deaths in the United States, 1,400 in the United Kingdom, 700 in Canada, and 500 in Australia. These figures assume that surgery is the first treatment in 83% of cases and that mortality without delay is 12%.
People who are unaware of their cancers may also be less cautious and take part in situations and activities where they may be at greater risk of infection.
When compared with a healthy population, people with cancer have been shown to be more vulnerable to more severe outcomes as a result of COVID-19.
Mitigating the risks
As the world continues to face the effects of the pandemic, it will be important for hospitals and clinics to remain vigilant in gathering information on best practices for safety and treatment.
To better educate patients and lessen fears surrounding the risk of infection, communication must be improved.
Hospitals must provide clearer communication regarding the facility’s or clinic’s safety measures and the risks associated with hospital visits. Patients must also be well-informed about the health risks associated with not only COVID-19 but also the delayed identification and treatment of breast cancer.
With this information, patients can engage in meaningful conversation with their healthcare provider to reach an outcome together, whether they are deciding on a course of treatment or to delay a procedure during the pandemic.
This sense of agency in decision-making has been associated with better patient outcomes.
As part of empowering patients through information, recommendations regarding the frequency and age to begin having breast cancer screenings should be better aligned. The lack of consistency may be putting patients at greater risk for presenting with more advanced stages of breast cancer. This problem has been compounded by the inability to have screening procedures due to COVID-19.
Advances in technology can help mitigate the risks in delayed screenings through telemedicine. The use of virtual appointments has been demonstrated to be helpful in answering questions, providing assessments, and facilitating follow-up with breast cancer patients during the pandemic.
Adopting new technology at the hospital may be another strong method of increasing efficiency and minimizing the risk of infection for patients and healthcare providers.
Wire-guided techniques remain the standard for tumor localization, but various wire-free techniques can help optimize workflow and reduce limitations in scheduling.
Wire-guided vs. wire-free
Wire-guided localization (WGL) was introduced in the 1970s and has become the global standard in marking breast cancer lesions.
It is done by inserting one or multiple wires into the breast adjacent to the lesion, a technique that has not changed much in 50 years.
One of the drawbacks of WGL is the need to coordinate among the patient, radiologist, surgeon, and pathologist because the procedure must be done on the same day as the surgery.
This can create scheduling obstacles for the people involved as well as for the hospital. WGL is also challenging and inconvenient from a patient-experience perspective.
The technique requires the lesion to be identified on the same day as the surgery, which can mean a long day spent waiting at the hospital between the two procedures. The protruding wire can also be displaced or transected during surgery, which can lead to inaccuracy, additional procedures, or migration.
Wire-free localization, on the other hand, is a much more patient-centered and efficient approach. It involves implanting a small marker in the breast, which can be detected using a wand and visualization tablet during surgery.
The localization procedure takes about 5 minutes, and afterward, the patient has the flexibility to have the procedure done that day or leave the hospital and return within 30 days.
So, clearly, by decoupling localization from surgery, physicians can optimize their respective workflows to ensure efficient and timely care for patients.
This has been shown to lead to a 34% increase in radiology departments’ scheduling capacity and a 41% increase in breast-conserving surgeries.
As breast cancer screenings, treatment, and surgery slowly return to pre-pandemic levels, the backlog of delayed procedures continues to put breast cancer patients and at risk populations in danger of delayed diagnoses.
To increase capacity, hospitals must continue to explore efficiencies, additional safety measures, new partnership models, and new technology to ensure patients are able to receive the care they need.
Patients must also take more responsibility for their own care by learning about the risks of delayed diagnosis or treatment. Still, providers must do their part to communicate clearly with a wide and diverse audience and address patient concerns.
The COVID-19 pandemic has changed every aspect of life, but healthcare workers and developers of medical technology must continue to put patient-centered care first.
About the author
Fazila Seker, Ph.D., is passionate about women’s health and social disparity issues within healthcare. She is the CEO and co-founder of MOLLI Surgical, a company that develops devices to guide precision surgeries for a better patient experience.
Fazila hosts a weekly Facebook Live show called “Breast Practices,” where experts and patients discuss topics in patient-centered care. She is also a frequent author and blogger on issues in women’s health.
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