Why do cancer patients have to undergo surgery

Hospitals: The cancer continues to grow, despite Corona

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"We are ready for a big rush." This sentence by Heinrich Iro, the medical director of the University Clinic Erlangen, can no longer get Christiane Stark out of her head. The rush refers to the many expected corona patients in German hospitals. Christiane Stark, 58 years old, is not one of them. Still, she would give anything to be treated in one of these hospitals. But she has no chance. Your operation has been postponed. She was informed by the patient management of the university clinic three days before her surgery appointment.

Stark, who does not want to be called by her real name, had colon cancer. She defeated cancer. But since the tumor was removed last year, she has an artificial anus. Its purpose is to prevent the surgical scar from opening again. On March 27, the exit should be relocated and Stark should get her old life back: out of the elastic pants and back to work. That was how she had imagined it for months. "For me, the operation would have been the last word on the subject of cancer," says Stark. But instead of being able to draw a line, Stark only knows at the end of March that she will have to wait. Four weeks, two months or another six? Nobody can tell her.

All over Germany, hospitals have to replenish intensive care places and vacate beds. As early as mid-March, Health Minister Jens Spahn asked the clinic managers to postpone all planned interventions and operations in order to prepare for the treatment of many people with the coronavirus. Exactly which operations are postponed is left to the hospitals. This presents many doctors with a dilemma, especially as long as the corona patient rush does not take place: They have to put off patients who now need their medical help in order to be ready for potential Covid 19 patients in the next few weeks.

Worse than the cancer diagnosis

"Of course we would like to operate on all patients who need it," says Robert Grützmann. He is in charge of surgery in Erlangen, where Stark is treated. But his clinic had to close fifty percent of all surgical beds in the past two weeks. Only half of all operations can take place; decisions are made based on urgency. "I then have to give priority to an acute colon cancer patient over the patient who needs to be relocated," says Grützmann. Medically, the patient with the stoma, as an artificial anus is called in technical jargon, is unlikely to have any long-term disadvantage. Most patients could live normally with a stoma, albeit with a reduced quality of life. "That is why such operations are among those that we can only carry out in exceptional cases at the moment."

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Stark knows that her life is in no danger because of the postponed surgery. It is always limited: "Since I have the stoma, I only go out of the house when I have to, for a doctor's appointment or to go shopping." The small intestine works continuously, and Stark cannot control bowel movements. The bag pinches and squeezes and rubs. But the idea of ​​having a hole in your stomach is much worse. Stark would like to go back to the town hall, where she works in administration. Time is of the essence: if she does not return to work by July 2020, she will no longer receive sick pay. "For me, the cancellation of the operation was worse than the cancer diagnosis," says Stark.

Only emergencies are operated on

She has therefore also written to the attending senior physician and tried to negotiate. Typically, patients have to stay in hospital for a good week after being transferred. "As soon as I can stand on my feet, you can send me home," she wrote to her doctor.

But the doctors' answer in March is clear: surgery is only performed in emergencies. That means: Stark could only be operated on if her stoma became infected. As long as her condition does not worsen, she will have to wait. Two weeks later, patient management contacted her, this time with a non-binding appointment for the end of April. A great relief for Stark. Grützmann estimates that after four weeks you can see for the first time whether the new capacity of intensive care beds will also be needed. But he also says: "We are assuming that the corona wave will not be a high one that will pass quickly, but rather a flat one that will last for weeks or months."

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If around 50 percent of all intensive care beds in clinics throughout Germany will be kept free for several months or will be occupied by people with a corona infection, what does that mean for those who are also dependent on intensive treatment in the hospital? For example for the 500,000 people who develop cancer every year?