Navigating a cancer diagnosis during a pandemic is no laughing matter, but John Smith couldn’t help but chuckle in disbelief at the unimaginable situation he finds himself in.

The 56-year-old from Belleville, Ont., son of the late Harry Leslie Smith, a.k.a. “the world’s oldest rebel,” was diagnosed with colorectal cancer in January. Surgery to remove three centimetres of rectal cancer was set for Friday at Sunnybrook hospital in Toronto. His surgeon’s office called Wednesday with the bad news. There would be no surgery until the coronavirus crisis had passed.

“There’s a sense of complete absurdity because you keep on going, ‘When will I wake up?’ ” Smith said from his home Thursday. “It’s one thing having cancer and then you throw a pandemic into the loop.”

Surgeries and treatments for cancer patients are being cancelled or postponed indefinitely across Ontario, as the province responds to the coronavirus outbreak. Small comforts that cancer patients rely on, like transportation services, clinic visits and having family at their side, are inaccessible, too.

Provincial Health Minister Christine Elliott asked Ontario hospitals to take a “planned approach on ramping down surgeries” on March 15, according to a spokesperson for the University Health Network, which includes the Princess Margaret Cancer Centre in Toronto.

Emergency surgeries continue, but cancer surgeries are among those on the chopping block, as hospitals work with Cancer Care Ontario, a branch of the health ministry, to determine what constitutes life-or-death.

“Unfortunately this is something we need to do unless that person’s life is in danger,” Elliott said on Friday.

Princess Margaret Cancer Centre is currently performing surgery if the treating physician feels the patient faces imminent harm if not treated within the next 14 days, and tracking every patient to make sure they are ready to be rebooked as soon as operating resources become available.

Richmond Hill resident Cris Dulfo’s full mastectomy, following a stage-three breast cancer diagnosis last November, had been scheduled for April 7 after three months of chemotherapy. The 46-year-old saw her surgeon Wednesday, only for the operation to be cancelled on Thursday.

“This was all smooth going, everything had been planned out, until we get slapped in the face with this,” said her husband, Steve Reich, who spoke to the Star on behalf of Dulfo, a native of the Philippines who speaks limited English.

Dulfo, who previously worked as a caregiver, has lost all her hair, and her nails have turned black from chemotherapy, Reich said. She didn’t take news of the cancellation well, especially with no indication of when the surgery would go ahead.

“She shut down a lot … I’m sure she wants to have everything done and in her mind she wants all this gone with,” he said. “The faster the better, right?”

Reich called hospitals in Montreal and Ottawa but was told the situation was the same in those cities. While the couple understands the risks of COVID-19, particularly to immunocompromised patients like Dulfo, they also believe all patients have a right to treatment, even in a pandemic.

“We have to figure out something … to serve the people who need it,” Reich said. “It’s terrible, this virus, but it’s also terrible for people who have cancer. Cancer can spread fast, right?”

The coronavirus has affected more than just surgeries for cancer patients. Outside of hospitals there are less drastic ways in which treatment regimens have changed, but they are often no less significant to patients.

For a lot of cancer patients, support groups are the backbone of their emotional resilience. But many of those groups have been disbanded for the sake of social distancing in the last few weeks. Some have been replaced with online groups, some have not.

“We absolutely know that (emotional support) plays a really important part of someone’s experience,” said Laura Burnett, vice-president of Cancer Information and Support Services for the Canadian Cancer Society. “Right now, that is changing because people can’t get together like they did prior to social distancing.”

On Wednesday, the Canadian Cancer Society suspended its Wheels of Hope program, which provided transportation to cancer patients to and from cancer-specific medical appointments. Patients must now turn to friends and family to get back and forth from their appointments.

That is, if those appointments still exist. For many patients, face-to-face meetings with doctors have given way to virtual appointments. Over 50 per cent of clinic visits at the Princess Margaret Cancer Centre are now happening virtually.

But virtual appointments can disrupt routines, and mean that, in some cases, alternative means have to be found for some tests.

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Dynacare provides many of those tests for cancer health-care providers.

According to Christopher Trevors, director of genetic testing at Dynacare, they’ve expanded their capacity for diagnostic tests as hospitals have begun to shift their resources to deal with the pandemic.

“Where we see the impact on patients being treated for cancer is in their ability to access the doctors like their family physician who they would go to with their health concerns, the physicians who order the testing or perform the biopsies which are sent to Dynacare for analysis,” said Trevors.

As a result, he said, they have had to adapt, working with physicians and clinics to use other sites or even patients’ homes to collect samples for testing.

Some radiology scans and screenings for women at high risk of developing breast cancer have also been put off amid the coronavirus crisis, according to MJ DeCoteau, the founder and executive director of Rethink Breast Cancer, a charitable organization dedicated to supporting young women with breast cancer.

The number of emails DeCoteau has received from women frightened about deferred surgery or radiation has grown in the past week. Rethink Breast Cancer has launched a social media campaign called #stayhomeforcancer to promote social distancing and is looking into providing professional psycho-social support, with a trained counsellor, for breast cancer patients as they deal with heightened anxiety during the pandemic.

“When you’re in active treatment you want to do everything you can to control the cancer, to make sure it’s not going to come back to those mind games of, ‘Oh, it’s being delayed. What’s the long-term impact going to be of that?’ That anxiety is huge,’ ” DeCoteau said.

In many cases, cancer patients now have to navigate those worries alone as hospitals close their doors to visitors to reduce foot traffic and promote physical distancing.

For Brian Fraser, a radio producer in Ottawa who was admitted to hospital with acute leukemia earlier this week, those new protocols meant holding a nurse’s hand while his parents, Rick and Sheila, and his two cats, Spiff and Pinwheel, talked him through a painful bone marrow transplant over video chat on Wednesday.

“It’s been truly, truly terrible not seeing them,” said Fraser, 25. “You realize quickly how much we take our families for granted.”

Fraser, like his fellow cancer fighters, asks people to practise social distancing — and to donate much-needed blood.

“If people stay home, the chances that I could see my family while I’m here … they go up,” Fraser said. “People going out to parties and stuff like that — you’re taking time away that I could have with my family.”

Meanwhile, Smith, who has colorectal cancer, will have to hold his own hand when he wakes up from surgery on Friday. His operation, which had been cancelled Wednesday, was rescheduled Thursday after doctors told him his case was reviewed

It cost Smith $400 to rent a social distancing-friendly limousine to drive from Brockville to Toronto early Friday morning. He will recover in the hospital for three to six days and then return home to isolation.

But to Smith, going under alone was better than not going under at all.

“I’d rather have it done now and take my chances rather than hope things can get better quickly,” he said. “I hope I’m proven wrong, that this gets cleared up and in two weeks we’re back to normal, but I don’t think we’re really going that way.”