Cancer Care During a Pandemic

By Madiha Kabeer, Biochemistry Major, 2022

Individuals all around the world with underlying health conditions have been deeply affected by the COVID-19 pandemic. People with preexisting critical illnesses and newly acquired conditions face many complications during treatment. Patients may face loneliness, delayed treatment, and difficulty in accessing healthcare. Cancer impacts a person’s life immensely regardless of the circumstances, and the pandemic has only created more hardships.

During the pandemic, many wards in healthcare sites were converted into intensive care units for COVID-19 patients. Some of these sites include cancer care wards, which faced decreased amounts of medical supplies, ventilators, pharmaceuticals, and beds allocated for cancer patients. In fact, COVID-19 patients are prioritized in healthcare facilities, leading to delays in cancer treatment. This makes it difficult for cancer patients to access the care and treatment they need.1

Delayed treatment can lead to complications for cancer patients as those who received treatment later than usual showed a decreased survival rate. The disease may spread to other areas of the body, tumors may not be removable, and chemotherapy may not be as effective. Depending on the severity of the malignancy, necessary procedures should not be avoided or delayed due to pandemic circumstances.2

Although treatment should not be delayed, the high risk of COVID-19 exposure in healthcare sites must be considered against the need for treatment.1 Cancer patients who contracted COVID-19 within 30 days of receiving chemotherapy showed an increased risk of death.3 Overall, there was an increased risk of death by 25% in these patients, putting cancer patients at the highest risk for fatality from COVID-19.4 Other treatments such as immunotherapy, surgery, and radiotherapy did not show an increased risk of death.3

A study conducted in New York City, a pandemic epicenter, investigated the effects of the virus on different cancers in the population. Common cancers within the U.S. population included in this study were lung, breast, prostate, and colorectal cancer. The pattern of increased risk of death with COVID-19 followed the overall known fatality rates of these cancers.4 The annual mortality for each cancer is as follows: “59.3% for lung cancer, 15.2% for breast cancer, 17.4% for prostate cancer, and 36% for colorectal cancer”.4 The mortality rates among COVID-19 patients within each of the common cancers investigated were “55% for lung cancer, 14% for breast cancer, 20% for prostate cancer, and 38% for colorectal cancer”.4

‘‘ These findings conclude that contracting COVID-19 increases the risk of death for cancer patients regardless of the type of cancer. ‘‘

During the pandemic, the number of individuals allowed to accompany the patient for consultations and treatments is limited. This restriction is due to the increased possibility of transmitting COVID-19 when more people enter and leave a healthcare site. To avoid this high possibility of transmission, hospitals and care facilities have decreased the number of clinic visits and may only allow the patient to come in alone, without family members who might usually accompany the patient. Patients may feel lonely during their hours of treatment or when receiving critical information about their progress during a consultation. There are many reasons cancer patients make frequent visits to the care site, including procedures such as surgeries, infusions, radiation therapy, imaging studies, and blood tests. Because it is still important for these visits to continue, the circumstances in which they occur have been vastly different.1

Continuing treatments with COVID-19 precautions creates many obstacles regarding access to healthcare and limitations during hospital visits.1 Ultimately, in comparison to a non-pandemic world, cancer care during a pandemic leads to the possibility of negative effects from delayed treatment.2 Treatment options must be compared with the risk of COVID-19 exposure in each patient’s unique situation of disease severity. Living through a pandemic with an underlying condition like cancer has been a harsh reality many individuals face — a vastly different experience from individuals free of critical illnesses and underlying health conditions.

[1] Kutikov, A., Center, F., Weinberg, D., Edelman, M., Horwitz, E., Uzzo, R., & Fisher, R. (2020, June 2). A War on Two Fronts: Cancer Care in the Time of COVID-19. Annals of Internal Medicine. https://doi.org/10.7326/M20-1133.

[2] Cortiula, F., Pettke, A., Bartoletti, M., Puglisi, F., & Helleday, T. (2020, March 19). Managing COVID-19 in the oncology clinic and avoiding the distraction effect. Annals of Oncology, 31(5), 553-555. https://doi.org/10.1016/j.annonc.2020.03.286.

[3] Yekedüz, E., Utkan, G., & Ürün, Y. (2020, October 6). A systematic review and meta-analysis: The effect of active cancer treatment on severity of COVID-19. European Journal of Cancer, 141, 92-104. https://doi.org/10.7326/M20-1133.

[4] Mehta, V., Goel, S., Kabarriti, R., Cole, D., Goldfinger, M., Acuna-Villaorduna, A., . . . Verma, A. (2020, July 10). Case Fatality Rate of Cancer Patients with COVID-19 in a New York Hospital System. Cancer Discovery, 10(7), 935-941. doi: 10.1158/2159-8290.CD-20-0516.

[5] Genentech. (2020, November 23). Personalized Cancer Care for All. https://www.gene.com/stories/personalized-cancercare-for-all?topic=personalized-health care.

[6] Alhalabi, O., & Subbiah, V. (2020, May 5). Managing Cancer Care during the COVID-19 Pandemic and Beyond. Science & Society, 6(7), 533-535. https://doi.org/10.1016/j. trecan.2020.04.005.