Discussion
We reported on a patient who had advanced cancer after refraining from visiting hospitals for more than two years due to fear of the COVID-19 infection and from her easy-going and laid-back personalities. This patient had multiple characteristics that could have led to a delay in receiving medical care during a disaster, and the combination of these factors may have had a long-term effect on the patient.
Typically, in disasters and crises, the importance of personal health tends to decrease temporarily, particularly in diseases such as breast cancer, which progresses relatively slowly.5-7, 10Moreover, in this case, the failure to diagnose cancer in multiple previous visits may have lowered the priority of breast symptoms in the pandemic. Indeed, previous studies have also shown that a previous benign diagnosis can decrease a patient’s suspicion of cancer.15
In addition, her personality may have had a significant role in this patient’s delay in visiting hospitals. This patient described herself as easy-going and laid-back. In fact, this patient did not seek timely consultation even after becoming aware of the worsening of her symptoms. If she had been seen earlier, it would have been possible to diagnose her disease at an earlier stage.
Another important characteristic is that she did not adequately consult with the people around her about her condition. There have been reports of cancer patients who delayed their visiting hospitals due to the loss of opportunities to communicate with their surrounding family and friends about their health conditions after the triple disaster.7 While this patient did not lose any family members from the COVID-19, her failure to actively seek support from her surroundings may have resulted in a lack of response, leading to a prolonged delay in seeking medical consultation. In this respect, this can be said to be a matter of personality, but it is also a matter of family and surrounding support.
Of course, there are limitations to what we can state from a single case. It is impossible to determine which factors contributed specifically and to what extent to the results. Nevertheless, one thing that is clear from this case is the possibility of long-term delays in hospital visits due to the simultaneous involvement of a variety of factors that may contribute to such delays, and it will be necessary for health care professionals to be fully aware of their patients’ backgrounds on a daily basis.
Moreover, a coherent strategy is reminders. For example, our clinic routinely requests patients to make their appointments when they revisit us in more than one year. Thus, we could not comprehensively identify those who had not made an appointment or seen a doctor one year later, thereby leading to the above situation. We must take measures to fill this gap, which is especially important under the ongoing COVID-19 pandemic. Further, the importance of such reminders has also been noted in regular medical practice.16 In addition, it is important to listen to the patient’s personality and family environment during regular medical consultations and through collaboration with other professionals, such as medical social workers, to guide the patient to a timely visit to the hospital, even in times of crisis.
In conclusion, we experienced an advanced breast cancer patient who refrained from seeing a hospital for more than two years because of fear of COVID-19 and from her easy-going and laid-back personalities. Various overlapping factors, such as lower health priorities, personality, and availability of surrounding support, may lead to prolonged delays in medical visits. It will be necessary to understand the situation of patients on a daily basis carefully and, drawing on this information, to remind high-risk patients in the event of a disaster or crisis. Also, further analysis would be needed to determine how each factor affects and leads to delays in long-term medical visits.