Elective Cancer Surgery Is An Oxymoron


Leonard Zwelling


         In the March 31, 2020 edition of The Houston Chronicle, Marc Boom (CEO of Methodist) and Peter Pisters (president of MD Anderson) penned an op-ed about the roles that hospitals must take in the coronavirus crisis. It was a platitude-laden piece about traditional exercises in patient care and what the hospitals of the Texas Medical Center are doing to combat the threat of the novel pathogen. Very nice.

         A colleague and I had proposed an editorial of a far more pithy nature that was vetoed by the powers-that-be at MD Anderson two weeks ago in anticipation of this piece. Wow! I hope it was worth the wait.

         This posture by the leadership of two of the large hospitals in the TMC goes on while at least one of them, MD Anderson, has ceased doing elective cancer surgery. Why?

         As anyone who has had a malignancy amenable to surgical intervention knows, that surgery for them is not elective. It is mandatory. In fact, I would argue, as the title of this blog does, that there is no such thing as elective cancer surgery any more than there is elective heart surgery at Methodist. If a patient needs a three-vessel by-pass procedure at Methodist, I sure hope he or she gets it. But I am certain that at least in a few cases, planned cancer surgery to extirpate malignant lesions was postponed at Anderson. Who is to say that was a good decision? Oh, I know. Me. It was a terrible decision.

         I have no idea what the leaders of academic medical centers are thinking by derailing clinical research and postponing planned surgery because of the coronavirus threat. The predicted peak of the outbreak is still some weeks away in Houston. Any way, is MD Anderson planning on filling up with Covid-19 patients in mid-April? The threat of that to the immune-compromised patients that usually fill MD Anderson and its clinics should be prohibitive. Could MD Anderson take the spillover of non-Covid-19 patients from the other hospitals? Sure. But MD Anderson is no place for a bevy of patients with a highly contagious infectious disease.

         This blog was very complimentary of the initial reaction of MD Anderson’s leadership to the coronavirus threat. Since that time, rather than continue the vital work of the cancer center, the leadership has sent everyone home, cleared out the labs, and stopped elective surgery. This seems particularly unwise to me. Cancer does not rest—even for presidents of institutions or the United States.

         And on a similar note, governments all over the world are using the coronavirus crisis to seize unbridled power over their people. Israel’s Benjamin Netanyahu has even shut the courts—the very ones in which he is to be tried shortly.

         When the history of the coronavirus threat of 2020 is written, there may be very few heroes beyond those doctors, nurses, technicians and first-responders who really faced the threat and stared it down.

         Given the latest projections, it appears that covid-19 will kill about 100,000-200,000 Americans, about three or four-times more than would be the case in a bad flu year. For this, we crippled the economy and gave up a whole lot of freedom. Historians will have to decide if it was worth it.

         I am quite sure that any cancer patient with scheduled “elective” surgery will decide that postponing a potentially curative surgical intervention was a terrible idea. I agree.

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