Maria* has finally just undergone a mastectomy. But the 10-week wait to remove her breast cancer has compounded the distress of the disease from the day of her diagnosis back in July.

Her doctor had told her he would have operated on her the following week if he could but she had to wait over two months for what was considered “urgent” surgery.

The young woman and her family have since spent every single day afraid and anxious.

“I have driven everyone around me mad,” Maria said.

But her husband, who lost three family members to cancer in one year and knows what he was up against, has had an equally hard time and everyone has suffered due to the delay.

“I have cried so much that I ended up at the polyclinic because my eyes dried out,” he said, expressing frustration that the situation was “urgent and dangerous” and, yet, they could do nothing but wait in limbo.

“It is shameful and unfair.”

Maria's experience is reflected by that of many others in a similar situation, with slashed operating lists at Mater Dei Hospital meaning breast cancer patients are having to wait for up to three months for surgery. 

Two advocacy groups, the Action for Breast Cancer Foundation and Europa Donna Malta Breast Care Support Group, have written to the health authorities to express "serious concerns" about the delays. 

Maria felt “attention is being paid to COVID-19 and not to people like me. If you have a toothache, you extract it immediately. But I could not remove the cancer inside me”.

No other option

She had immediately felt the appointment she received for the surgery was too far away and asked if she could do it privately. Her husband was ready to “sell everything and anything” for his family’s health. But patients in her situation have nowhere to turn: undergoing breast cancer surgery privately was not advisable because the technique and equipment were only available at Mater Dei Hospital.

The uphill struggle towards recovery has now started but, at least, it has started, the couple said.

*Name changed to protect the person’s identity.

‘No catastrophic impact’

Cancer care, which in the UK resulted in a crisis due to missed urgent checks, was prioritised in Malta throughout the pandemic and did not experience catastrophic impacts, according to Stephen Brincat, consultant oncologist at Mater Dei Hospital.

The Telegraph had reported that a cancer crisis was replacing COVID-19 as experts warned that many patients were never referred by their GP or kept away for fear of adding to virus pressures facing the NHS.

While data on the subject was not available, Brincat could say that the department “certainly did not end up with a big backlog, or major hiccups in care delivery”. Treatment carried on smoothly, despite the difficulties that COVID-19 presented.

The problem of COVID vis-à-vis cancer care turned out to be more on a psychological and communication level, he maintained, as patients’ relatives could not visit them, except “at the end”. This situation was even more critical when it came to those in palliative care.

Generally, relatives were also not allowed to accompany patients and act as a back-up to any explanations given, Brincat pointed out.

“Patient access to relatives and their isolation was the major issue in the coronavirus pandemic, rather than delivery of care,” Brincat highlighted, adding there was enough flexibility to manage the situation without buckling under.

Brincat said the pandemic had also brought to the fore the realisation that some routine checks could easily be postponed for six months.

The situation has now reverted to the usual 60 outpatient visits every morning, after some of these had been postponed because of the outbreak.

But most of these routine check-ups were carried out for patients’ peace of mind and not necessarily because they were needed.

“It is quite hard to convince patients that they are cured and do not need to come for visits,” he said, explaining that it was more about the psychological benefit of being seen and the reassurance that came with that.

Many cancer patients also got COVID-19 and survived, Brincat pointed out, adding that cancer covered a broad spectrum and not all were equally ill, while many enjoyed a good quality of life and had reduced risks of relapse.