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The federal government has health centers to delay nonessential surgeries while weighing the severity of patients鈥� conditions and the availability of personal protective equipment, beds and staffing at hospitals.

People with cancer are among those at high risk of complications if infected with the new coronavirus. It鈥檚 1.8 million people will be diagnosed with cancer in the U.S. this year. More than 600,000 people are chemotherapy.

That means millions of Americans may be navigating unforeseen challenges to getting care.

Christine Rayburn in Olympia, Washington, was diagnosed with breast cancer in mid-February. The new coronavirus was in the news, but the 48-year-old did not imagine the outbreak would affect her. Her doctor said Rayburn needed to start treatment immediately. The cancer had already spread to her lymph nodes.

鈥淭he cancer tumor seemed to have attached itself to a nerve,鈥� said Rayburn, who was a schoolteacher for many years. 鈥淚 feel pain from it on a regular basis.鈥�

After getting her diagnosis and the treatment plan from her medical team, Rayburn was focused on getting surgery as fast as possible.

Meanwhile, the coronavirus outbreak was getting worse, and Seattle, just an hour north of where Rayburn lives, had become a national focal point.

Rayburn鈥檚 husband, David Forsberg, began to get a little nervous about whether his wife鈥檚 procedure would go forward as planned.

鈥淚t did cross my mind,鈥� he said. 鈥淏ut I did not want to bother with that possibility on top of everything else.鈥�

Two days before Rayburn鈥檚 lumpectomy to remove the tumor, Forsberg said, the surgeon phoned, 鈥減retty livid鈥� with bad news. 鈥淪he said, 鈥楲ook, they鈥檝e canceled it indefinitely,鈥欌�� Forsberg remembered.

The procedure had been scheduled at in Olympia, a facility run by Providence Health & Services. Across Washington, hospitals were calling off elective surgeries, in order to conserve the limited supply of personal protective equipment, or PPE, and to prevent patients and staffers from unnecessary exposure to the new coronavirus.

鈥淚t just felt like one of those really bad movies, and I was being sacrificed,鈥� Rayburn said.

鈥淚t was like we just got cut off from the experts we were relying on,鈥� her husband said.

The hospital said it would review the decision in a few weeks. But Rayburn鈥檚 surgeon said that was too long to wait, and they needed to move to Plan B, which was to begin chemotherapy.

Originally, chemotherapy was supposed to happen after Rayburn鈥檚 tumor surgery. And rearranging the treatment plan wasn鈥檛 ideal because chemotherapy isn鈥檛 shown to significantly shrink tumors in Rayburn鈥檚 type of breast cancer.

Still, chemotherapy could help stop the cancer from spreading further. But as the couple figured out the new treatment plan, they ran into more obstacles.

鈥淪he needed an echocardiogram, except they had canceled all echocardiograms,鈥� said Forsberg.

They spent days on the phone trying to get all the pieces in place so she could start chemotherapy. Rayburn also started writing to her local lawmakers about her predicament.

Hospitals Prioritize Urgent Cases

In mid-March, Washington Gov. Jay Inslee most elective procedures, but he did carve out exceptions for certain urgent, life-threatening situations.

鈥淚t actually said that it [the ban] excluded removing cancerous tumors,鈥� Rayburn said.

Providence hospitals use algorithms and a team of physicians to figure out which surgeries can be delayed, said , chief executive of Providence Health in the Washington-Montana region.

鈥淭here are no perfect decisions at all in any of this,鈥� said Couture. 鈥淣one.鈥�

Couture would not talk about specific patients but said she assumes other cases were more urgent than Rayburn鈥檚.

鈥淲ere there other patients that even had more aggressive types of cancer that were [surgically] completed?鈥� Couture said. 鈥淎s sick as you are, there can be other people that are needing something even sooner than you do.鈥�

Couture said hospitals are burning through supplies of masks, gowns and gloves and need to make tough calls about elective procedures.

鈥淚 don鈥檛 like that, either, and it鈥檚 not the way that we want our health care system to work,鈥� Couture said.

Across the Providence hospital system, personal protective equipment is being used much faster than it can be replenished, she said.

No Single Standard

At the American Cancer Society, Deputy Chief Medical Officer Dr. is hearing from patients across the country who are having their chemotherapy delayed or surgery canceled.

鈥淭here was someone who had a brain tumor who was told they would not be able to have surgery, which was, basically, and appears to be a death sentence for that patient,鈥� said Lichtenfeld.

This is uncharted territory for cancer care, he said. Hospitals are making these 鈥渄ecisions on the fly鈥� in response to how the pandemic looks in a particular community. 鈥淭here is no single national standard that can be applied. I am afraid this is going to become much more common in the coming weeks.鈥�

The cancer society that people postpone their routine cancer screenings 鈥� for now.

The American College of Surgeons has published on how to triage surgical care for cancer patients. But Lichtenfeld said every decision ultimately depends on the availability of resources at the hospital and the pressures of COVID-19. In Washington state, which has been hit hard, hospitals are shifting surgical space and beds away from other kinds of treatment.

鈥淲e need to forecast two to three weeks down the line when there are more patients that are ill,鈥� said medical director of infection prevention at the Seattle Cancer Care Alliance. 鈥淲e need to make sure there鈥檚 adequate bed capacity.鈥�

Pergam said the care alliance is adjusting treatment plans and, at times, avoiding procedures that would keep cancer patients in the hospital for a prolonged period.

鈥淚t really depends on the cancer and the aggressive nature of it,鈥� he said. 鈥淲e have looked at giving chemotherapy in the outpatient department and changing the particular regimens people get to make them less toxic.鈥�

But Pergam said they expect to keep doing urgent surgeries for cancer patients, even as the pandemic grows worse.

Christine Rayburn in Olympia was steeling herself for the months of chemotherapy to come: staying inside her home and even avoiding contact with her adult daughters, to avoid any possible exposure to the coronavirus.

Then, two weeks ago, the surgeon called again. She had persuaded the hospital to allow the surgery after all, 10 days later than initially planned.

Rayburn and her husband wonder what would have happened if they hadn鈥檛 spoken up or pushed to get her lumpectomy back on the hospital鈥檚 surgical schedule. Forsberg said it鈥檚 possible they could have ended up without the care Rayburn needed.

鈥淚f we didn鈥檛 say anything, in my mind that may be where we would be at,鈥� he said. 鈥淏ut in our minds, that was not an option.鈥�

This story is part of a partnership between聽聽and Kaiser Health News.