One in seven patients worldwide missed their planned cancer surgeries during the lockdown, according to a new study that has left experts concerned about its impact on the long-term survival of these patients.

Published in The Lancet Oncology, the study involved more than 20,000 patients suffering from 15 most commonly reported types of cancer — colorectal, oesophageal, gastric, head and neck, thoracic, liver, pancreatic, prostate, bladder, renal, gynecological, breast, soft-tissue sarcoma, bony sarcoma, and intracranial malignancies. The analysis also involved 5,000 surgeons and anesthetists across 466 hospitals in 61 countries — classified as “high income,” “upper middle income,” and “lower middle income.”

The study found that about 15% of cancer patients didn’t go through with planned surgeries during full-fledged lockdowns in countries. It also found almost all of them had Covid19-related reasons for it. Moderate lockdowns, too, had a similar impact. Whenever there was an increase in cases of Covid19, rates of operation for cancer patients fell.

Not only that, of the non-operated patients, 179 had progressed to unresectable disease, which is when it becomes impossible for doctors to remove the cancer tissue entirely through surgery. Additionally, at least 48 patients died before their planned surgery — 34 due to non-Covid related causes and the rest due to Covid-related complications.

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1,566 of the patients included in the study were from India, which was categorized as a “lower middle income” country. The study noted that patients belonging to countries in that category were at the highest risk of missing their surgery.

“The most vulnerable patients to lockdown effects were those in lower-income countries, where capacity issues that were present before the pandemic worsened under lockdown restrictions. Patients in these environments were at highest risk of cancellation, despite being younger and having fewer co-morbidities,” Aneel Bhangu, a senior lecturer in surgery at the University of Birmingham in the U.K., who was the co-lead author for the study, said in a statement.

“Accessing healthcare facilities was difficult for patients during lockdown restrictions,” Shailesh Shrikhande, deputy director of Mumbai’s Tata Memorial Hospital, who had collaborated with the researchers on the study, told Hindustan Times. “There was also fear about Covid19 infection and lack of information among patients that may have resulted in the delay,” he added.

The findings painted a bleak picture of access to essential, life-saving services amid a global pandemic that hit us out of the blue. However, while preparing for a healthcare crisis of this scale may have been challenging, medical practitioners believe it did serve as a wake-up call to build a more robust healthcare system that wouldn’t crumble so easily.

“While lockdowns are critical to saving lives and reducing the spread of the virus, ensuring capacity for safe elective cancer surgery should be part of every country’s plan to ensure continued health across the whole population,” James Glasbey, a doctoral research fellow in global surgery at the University of Birmingham, who was the other co-lead on the study, told the press.

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Glasbey added that “to prevent further harm during future lockdowns, we must make the systems around elective surgery more resilient — protecting elective surgery beds and operating theatre space, and properly resourcing ‘surge’ capacity for periods of high demand on the hospital, whether that is Covid, the flu or other public health emergencies.”

Bhangu also recommended a relatively short-term plan to help mitigate the problem by suggesting that “surgeons and cancer doctors should consider closer follow-up for patients that were subject to delays before surgery.”

In the meantime, building a more robust healthcare system remains the primary, long-term goal since the pandemic impacted not just cancer patients but also people living with a variety of chronic illnesses who couldn’t access treatment during the pandemic. The lack of prenatal hospital care during the first wave had also left many pregnant Indian women helpless.

Essentially, we cannot let one healthcare crisis overshadow the health struggles of millions of people dealing with multiple other illnesses. “Cancer will not wait for Covid19 to disappear,” Shrikhande summed up, advocating to “plan our hospitals… and triage well to face such challenges in the future.”