On March 18, Beth Purvis had a 19 mm tumor removed from her right lung. The surgery was part of a four-year trial to keep her advanced colon cancer at bay.
But a week before she was due to have her potentially life-saving surgery, Beth received a call to tell her that it had been canceled, along with all other planned surgeries, to free hospital beds for coronavirus patients.
On the day she should have had surgery on Good Health, 40-year-old Beth, an Essex legal assistant, was crying and scared.
Beth Purvis, 40, a legal assistant from Essex, was designed to remove a 19 mm tumor from her right lung
To this day, she had carefully prepared and arranged childcare for 11-year-old Joseph and Abigail, age 10, so that her husband Richard, a painter and decorator, could continue working while she was in the hospital.
‘I understand that the hospital must make beds and keep beds available for intensive care. But that doesn’t make it easier to deal with it, “she says.
“I feel exhausted trying to juggle everything – educating the kids at home, working and dealing with the emotions surrounding not having the surgery. The fear of what could happen if I don’t get it in time is paralyzing. ‘
Beth was diagnosed with colon cancer in 2016 and has had three surgeries and 26 chemotherapy treatments.
She was in remission for 14 wonderful months before a new tumor was found in her right lung in January.
“Although my life expectancy was uncertain after secondary tumors were found, there was stability knowing there were treatment options – this surgery was a lifeline,” she says. “But because of Covid-19, I have no idea what will happen next or whether there will be treatment because the expertise, resources and equipment are needed elsewhere.”
But the potentially life-saving operation was canceled to release hospital beds for COVID-19 patients. Mrs. Purvis is pictured with her children Joseph and Abigail and her partner Richard
Two weeks ago, Sir Simon Stevens, the director of NHS England, advised hospitals to suspend all choice activities from April 15 for at least three months.
About 700,000 people per month undergo some form of non-emergency surgery, including cataract surgery, hernia repair, and hip and knee replacements.
Everything will now be delayed as the NHS prepares for the peak of coronavirus infections; most patients do not receive alternative data yet, because no one is sure when the crisis will end.
NHS England hopes that this move will release approximately one third of our 100,000 hospital beds for coronavirus patients.
But while canceling a hip replacement can hurt a patient for longer, for some cancer patients like Beth, an indefinite delay can be a matter of life and death.
Sir Simon said that cancer treatment and other emergency care will continue as usual.
But a week ago, Barking, Havering, and Redbridge University Hospitals NHS Trust were the first to announce that it was discontinuing chemotherapy and routine cancer surgery for two weeks. Other trusts are expected to follow suit as they are forced to prioritize who gets treatment.
Ms Purvis said that the NHS’s decision to cancel her surgery made her tearful and scared
An NHS guide published in England earlier this month warned hospitals: “We have to take into account the small possibility that the cancer services facility will be compromised due to a combination of factors including staff illness and supply chain shortages.”
It suggested that physicians “categorize patients into priority groups 1-6,” with top chemotherapy priority, which is viewed as “high-quality curative therapy [greater than 50 per cent] chance of success ‘.
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This week: sunbathing keeps you safe
“ Vitamin D plays a role in your immune system, ” said Dr. Andrew Birnie, a dermatologist advisor at East Kent Hospitals University NHS Trust. But there is no evidence that higher or lower vitamin D levels play a role in the outcome of a Covid-19 infection.
“As for UV murder of the virus? Again there is no evidence to suggest that. This idea that sunlight kills certain germs is not something that is an established medical practice. It’s worth noting that anyone who enjoys the sun should apply sunscreen and don’t think it’s a safety measure against Covid-19.
“Anyone on social media who tries to distract from the established message of hand washing, alcohol gel, and social distancing endangers people’s lives.”
If a patient is given palliative cancer therapy with little chance of surviving for more than a year, they will receive the lowest priority.
For surgical cancer patients, the lowest priority is where surgery can be delayed for 10 to 12 weeks without “no predicted negative outcome.” Emergency surgery for cancer is a priority.
Another reason some cancer treatments are delayed is to reduce the chances of people with compromised immune systems contracting Covid-19 because of their cancer therapy because the symptoms would be much more severe.
Beth doesn’t meet the criteria for emergency cancer surgery and fears the delay.
“So many things are going through my mind,” she says. ‘We don’t know if this is a new tumor or a tumor that was left behind and growing last time. We don’t know until I’ve had a biopsy – and that’s been postponed.
“I can’t afford such a delay with my history. I don’t know if the tumor is still operating at the end of the crisis. ‘
Beth was 34 when her symptoms started in April 2014 with constipation, diarrhea, and bleeding. My GP said it was irritable bowel syndrome, with the bleeding probably due to an anal fissure [a small tear in the anus caused by frequent diarrhoea or constipation]She remembers.
But her symptoms persisted until April 2016, when she felt a bulge protruding from her back passage. “I thought it was a rectal prolapse [where part of the bowel pushes through] and I went to the emergency room, “she says.
Beth was referred to a colorectal surgeon for testing – and three months later, a closer look revealed a tumor.
“Since I was so young, I didn’t expect it to be cancer,” she says.
Ms Purvis had carefully prepared her surgery and arranged childcare for her children
Colon cancer is the fourth most common cancer in the UK. More than 42,000 cases are diagnosed each year and 16,000 patients die. The cause is unclear, but some factors increase the risk, such as age (age 50 and older), a family history, and an unhealthy lifestyle.
But Beth had none of these risk factors. “I ride horses, I’m not overweight, and I’m very picky about what we eat,” she says. Her colon cancer was stage 3, which means it had already spread.
“It was in six lymph nodes in my abdominal wall, but I was told it was still curable because otherwise I was healthy,” she says. “I had surgery and six months of chemotherapy. Then I continued. ‘
But in November 2017, a scan showed cancerous growth on both Beth’s lungs. “Genetic testing also showed that I have a mutation called BRAF, which usually means the cancer is aggressive,” she says.
“They said surgery wouldn’t help because the cancer would just grow back. I was given six months to three years to live and offered palliative chemotherapy to limit tumor growth. You can’t process that kind of news. ‘
The chemo made Beth so sick that she decided to discontinue treatment. “I felt so sick that I couldn’t get out of bed, let alone take care of the kids or work,” she says.
But surprisingly, the tumors in Beth’s lungs didn’t grow. “After nine months without chemo, because the cancer had not progressed, the surgeons thought I might benefit from having the tumors removed,” she says. “I was thrilled.”
In September 2018, Beth had surgery to remove the tumors in her lungs. “After that I got up and was active very quickly and I recovered very well,” she says.
‘I understand that the hospital must make beds and keep beds available for intensive care. But that doesn’t make it easier to deal with, ”Purvis said
She had remission for 14 months before a routine scan in January this year revealed a 19mm tumor on the bottom of her right lung.
An operation to remove this offered Beth the hope of being cancer-free. “It is heartbreaking when the surgery is canceled,” she says. “Surgery worked last time.”
Cancer charities report reports of concerned patients in a similar position.
Professor Charles Swanton, chief physician at Cancer Research UK, said, “The full picture of how Covid-19 will impact cancer care is not yet clear.
Treatment decisions on a case-by-case basis should be based on the risks and benefits of the patient. Inpatient hospital care, including after surgery, can expose cancer patients to the virus, and we know that some of them are at higher risk of complications from viral infections. ‘
Beth spoke to her oncologist on the phone last week.
“Her opinion was that the surgery would be too risky for me at the moment,” she says. “We are going to review the position in four weeks and assess the risks of possibly starting with a less aggressive chemo, which I dread.
“I beg people to listen to the official advice and stay home. Because cancer patients must overcome this crisis as soon as possible. ‘