One year has passed since the number of COVID-19 cases increased from dozens to hundreds to thousands per day in a matter of weeks, and reached its highest daily peak in the United States on January 8, 2021, of more than 312,000 new cases.
One year into the pandemic, what have we learned about the impact of COVID-19 on cancer diagnosis and treatment? Have researchers been able to quantify the level of risk involved with in-person medical appointments? Are COVID-19 vaccines safe for patients with cancer?
Although many providers in the healthcare community were operating on assumptions 1 year ago because much about the coronavirus was largely an unknown, research conducted during the past year has begun to provide important answers for patients with cancer.
Delays in Cancer Screenings and Treatment Related to COVID-19
A study published in JCO Clinical Cancer Informatics showed that COVID-19 has led to decreases and delays in cancer treatment and diagnoses. During the early phases of the pandemic, in April 2020, cancer screenings decreased significantly, by 85% for breast cancer, by 75% for colon cancer, by 74% for prostate cancer, and by 56% for lung cancer.
During the same period, researchers noted significant reductions in patient visits for diagnosis and treatment, including 74% less hospital outpatient visits, 70% less new patient visits, and 60% less established patient visits.
A separate survey from the American Cancer Society Cancer Action Network showed that 79% of patients with cancer who were receiving active treatment reported delays in care. A total of 17% of the patients said that treatments, such as chemotherapy, radiation, and hormone therapy were delayed, and 78% of the patients who were not receiving treatment at the time also reported delays in preventive care. Of all the patients with cancer and survivors who were surveyed, 20% expressed concern that their cancer could be progressing or returning because of these challenges.
Doctors are bracing for a negative impact on patient outcomes caused by treatment and diagnosis delays. For example, Director of the National Cancer Institute Norman E. “Ned” Sharpless, MD, estimates an additional 10,000 deaths from breast cancer and colorectal cancer will occur during the next decade.
The Emergence of Telehealth
One positive development from the pandemic is that healthcare providers and patients quickly adopted telehealth solutions. Telehealth, or telemedicine, eliminates concerns about coronavirus exposure while allowing patients to see doctors in a way that’s more convenient and often less expensive.
Telehealth also opens the door to more frequent virtual visits with less risk for exposure to the coronavirus. Patients who may have been avoiding in-person visits, despite concerns about their condition, can use telehealth to ask their doctors about whether the risk of inaction outweighs the risk of exposure to the coronavirus.
Although overall the use of cancer services decreased during the pandemic, especially during the early phases, the situation could have been much worse if not for the shift to telehealth. Healthcare providers are working to improve telehealth offerings in terms of quality, security, and the ability to build relationships between patients and doctors in a virtual environment.
Research: Cancer Treatment Does Not Increase the Risk of COVID-19 Severity
Patients with cancer were initially believed to have a higher risk of serious COVID-19 complications than those without cancer. However, according to a study from Memorial Sloan Kettering in New York that was published in Nature Medicine, there was no significant association between having metastatic cancer, recently receiving chemotherapy, or having major surgery within the previous 30 days and hospitalization or severe respiratory illness resulting from COVID-19. The most frequent cancer types in the study were breast, colorectal, and lung cancer.
Because medical workers have been among the first to be vaccinated with the COVID-19 vaccine, hospitals and medical facilities are now much safer than they were 1 year ago. Given these developments and recent research, patients with cancer should no longer delay screenings or treatments because they are afraid of exposure to the coronavirus.
COVID-19 Vaccination Is Generally Safe for Patients with Cancer
Although the effective response to the COVID-19 vaccine may not be the same for patients who are immunosuppressed because of active cancer treatment, receiving the vaccine is generally safe and encouraged for patients with cancer. Some healthcare professionals and researchers are pushing for patients with cancer to receive priority access to the vaccinations.
The Pfizer/BioNTech and Moderna vaccines are not live-virus vaccines, which reduces the likelihood of side effects for immunosuppressed patients with cancer. Patients should consult with their healthcare provider before receiving any vaccinations.
The Road Ahead
There are many reasons for optimism. COVID-19 vaccinations are well underway, and new vaccines are on the verge of being introduced. Medical facilities are safer. The risks related to COVID-19 for patients with cancer are not as bad as were initially feared. Telehealth has gone mainstream.
Although delays in cancer screenings and treatments will have an impact on outcomes, patients with cancer should feel more confident in their ability to make informed decisions. Challenges remain, but recent research gives reasons for hope as the light at the end of the tunnel shines brighter with each passing day.