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.