2021-11-23 02:18:17 UTC
Late diagnosis of tumours in children collateral damage of COVID-19,
Lack of in-person visits with family doctor a factor in diagnosis,
CBC Radio · Posted: Nov 21, 2021 4:00 AM ET | Last Updated: November 21
Dr. Sheila Singh, a pediatric neurosurgeon at McMaster Children's
Hospital in Hamilton, says the health-care system should be able to stay
on top of cancers and all of the other diseases that have been given
less priority during the COVID-19 pandemic. (Submitted by Dr. Sheila Singh)
Dr. Sheila Singh is used to explaining complex medical situations in
simple terms. The pediatric neurosurgeon at McMaster Children's Hospital
in Hamilton says that lately, she's seeing too many oranges and
grapefruits and fewer ping pong balls.
That's not good, and it could signal that the COVID-19 pandemic has
delayed the diagnosis of many pediatric diseases, sometimes with
"You can imagine a tumour that's the size of a ping pong ball, it's
easier for me to work around and remove it," she said. "But if that ping
pong ball-sized tumour grows to the size of an orange or a grapefruit,
the tumour has grown to a size where it's much more difficult now to
Singh told Dr. Brian Goldman, host of White Coat Black Art, that she is
now seeing two to three times more oranges and grapefruits than before
the pandemic. In other words, the tumours have been left to grow much
longer due to delays in diagnosis.
Singh says she believes the delays in diagnosis have been caused by
patients staying away from hospitals because:
They are afraid of catching COVID-19.
There is a lack of in-person visits with their family doctor.
There is an anchor bias to look for COVID-19 symptoms to the detriment
of flagging other serious diseases.
"There's no doubt there will be collateral damage," she said, "and some
of that will be death and poor outcomes from diseases that could have
had better outcomes."
Singh says she remembered a recent patient, a young girl who had a
tumour that typically grows in one place in the brain. "This little girl
came in and this tumour was actually in four places in her brain. And
let me put it this way, two out of those four places I'd never seen this
brain tumour in before." Instead of doing one surgery, Singh had to do
several risky and difficult operations.
Doctors worry they won't be able to help every cancer patient diagnosed,
treated late due to COVID-19
THE DOSEStudies reveal the unintended consequences of delaying
surgeries, drop in ER visits due to pandemic
As a pediatric doctor, Singh says that it has been heartbreaking to see
some of the children whose cancers have progressed much further than the
pre-pandemic norm. "I feel like I've been practising in a Third World
country. I have seen disease that has spread so far that it's almost
like cases I've read about in rural India. It's been quite difficult and
Pediatric cancer specialists at CHEO, formerly the Children's Hospital
of Eastern Ontario, in Ottawa also saw fewer patients coming in the
early days of the pandemic, when parents said they feared going to the
The COVID fallout: tumours as big as oranges
Dr. Sheila Singh, a pediatric neurosurgeon at McMaster Children’s
Hospital talks about the enormous collateral damage caused by the
pandemic. She's now seeing tumours as big as oranges and grapefruits,
instead of ping pong balls. Dr. Singh blames it on prioritizing COVID
over all else, telling people not to come to hospital, and relying too
much on virtual health care -- all lessons for the future. 26:30
Early signs of widespread diagnosis delays
Early research suggests that later diagnosis of illness in children due
to the pandemic may extend to other serious illnesses, not just cancer.
In a study published earlier this year in the medical journal Pediatric
Diabetes, researchers in Alberta found that more children are being
treated for diabetic ketoacidosis, a serious and potentially fatal
complication of diabetes.
The authors suggest that parents may have been reluctant to access
medical services because of fear of COVID-19 and that "increased virtual
visits resulted in reduced face-to-face contact with health-care
providers and may have contributed to the under-recognition of the
severity of illness."
Pediatric neurosurgeon Dr. Patrick McDonald says he wants to make sure
that lessons are learned from what was done right and what was done
wrong in providing adequate care during the COVID-19 pandemic.
(Submitted by Dr. Patrick McDonald)
Dr. Patrick McDonald says he remembers the challenges of the lockdowns.
For much of the pandemic, McDonald headed up the pediatric neurosurgery
division at B.C. Children's Hospital in Vancouver. In the early days of
COVID-19, "I think all of us struggled with the issue [of] how do we
make sure that families know that they can still access care. It might
be a little more challenging, and we might have to do it initially by
He said that "it's a legitimate concern that people might not be able to
or might not be accessing care in a timely fashion."
Push for more in-person care
In October, the Ontario Ministry of Health and the College of Physicians
and Surgeons of Ontario issued a letter that encouraged doctors to
resume in-patient visits over virtual appointments.
"The standard of care is often difficult to meet in a virtual care
environment," the letter stated. "In-person care is essential for
certain conditions and services or where physical assessments are
necessary to make an appropriate diagnosis or treatment decision."
Singh says it's imperative that children undergo an in-person physical
exam to receive a proper diagnosis. (JD Howell)
That's particularly true when examining a young patient, Singh stressed.
"There's so much room to miss a diagnosis when you're staring at a child
on a screen."
One of the common symptoms of a brain tumour in a child is macrocephaly,
a technical term for an enlarged head, which Singh said can be a
challenge to identify during a virtual visit.
"Depending on the angle at which you're looking at a child, you might
not even notice how big their head is or even be alarmed about it,
whereas if that child walked into a room, it'd be the first thing you'd
notice about them."
McDonald says he believes that it may be another year before the full
impact of delayed diagnosis due to COVID-19 is really understood. When
the data does emerge, he stressed that we need to carefully examine what
happened to understand why people may not have sought out the care their
"There may be another pandemic, and we want to make sure that we learn
appropriate lessons for what we did right and what we did wrong in
providing adequate care," he said.
700 families waiting for children's health services at Toronto hospital
as pandemic backlog grows
In the meantime, Singh offered two pieces of advice to parents. First,
she said, "It's safe to go to your hospital." And second, "I would
really encourage parents not to accept a virtual visit as being a proper
way to diagnose your child."
Singh stressed that when parents are concerned about their child, an
in-person physical examination is imperative to receive a proper diagnosis.
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