by Mona Jhaveri - December 6, 2021

The COVID-19 pandemic has wrought havoc on the lives of pretty much everyone in the world. It started in late 2019 and is still ongoing today, nearly two years later. At the moment of writing this blog post, in November 2021, the COVID pandemic had taken more than 5 million lives. More than 256 million people were infected with this disease across the globe.

It’s an understatement to say that healthcare systems worldwide were not prepared for a pandemic of this magnitude. Hospitals were overcrowded, and many had to turn away patients who weren’t admitted quickly enough or whose condition wasn’t deemed severe enough for admittance.

The COVID pandemic had a significant impact on cancer care and treatment as well. As the world reeled from the first wave of this devastating virus, it became clear that cancer centers would have to adapt their services to provide for patients who were caught between a rock and a hard place – faced with both a deadly virus and their health condition.

In this blog post, we will explore how COVID-19 impacted each aspect of cancer care and discuss what needs addressing for new systems to be sustainable long term.

COVID-19 Regulations

COVID-19 is a disease caused by the novel coronavirus, never-before-seen in humans. It spreads via droplets and aerosols in the air. This means that it can be contracted through close contact with an infected person, such as if an infected person breathes, talks, coughs, or sneezes in proximity to healthy individuals.

Because of the way COVID spreads, unique regulations had to be put into place to protect the general population and slow down the spread of the virus. These regulations include:

  • Mandatory face masks
  • Mandatory quarantine of infected individuals
  • Lockdowns
  • Social distancing
  • Travel bans, closed borders, and more

The main goal of these regulations is to prevent gatherings of large groups of people to slow down the spread of COVID-19. This has created a lot of confusion and anxiety among the public, including cancer patients, who faced new challenges in their treatment.

How COVID-19 Affects Cancer Patients

Certain populations are more at risk of being affected by the novel coronavirus than others. Cancer patients have been one of the most affected for many reasons.

For example, patients undergoing chemotherapy or receiving radiation treatment have compromised immune systems, making them more susceptible to illnesses such as COVID-19.

Evidence suggests that cancer itself can lower immunity and increase vulnerability to viral infections in some cases.

Blood cancer (hematologic malignancy), especially, is linked to a compromised immune system.

Furthermore, cancer patients and even survivors with a personal history of cancer are more likely to develop a severe illness from COVID-19.

All of this means that cancer patients are at a higher risk of contracting COVID-19 and face many challenges when it comes to fighting off this disease.

As healthcare systems scrambled to accommodate this new pandemic, they had to make some changes that would significantly impact the lives of cancer patients.

Cancer Screening

One of the first areas of cancer care to be affected was cancer screenings. The goal of cancer screenings is to detect the early signs and symptoms of a variety of cancers. This enables patients to receive prompt care and treatment before their condition becomes too severe.

With COVID-19, however, this process became more complicated due to unique risk factors associated with the virus itself as well as new social distancing guidelines that were implemented.

Screening tests were paused or temporarily canceled in many countries around the world. This meant that patients with signs and symptoms of any sort, including cancer, were left without diagnosis or treatment for an indefinite period of time.

Studies show that in the United States, at the height of the pandemic in April 2020, the number of cancer screenings fell significantly compared to the same time period the previous year. The reduction of screenings was as follows:

  • Breast cancer by 85%
  • Colon cancer by 75%
  • Prostate cancer by 74%
  • Lung cancer by 56%

In Brazil, the rates of breast cancer screenings fell by 47%, and of colorectal cancer screenings by 46%. Similar reductions were seen in other countries as well, such as England and Australia.

Even though the pandemic is more under control than it used to be in 2020 and cancer tests and screenings are starting to get back on track, screening numbers are still not back to normal in some regions.

Cancer Treatment

Unfortunately, even cancer patients in active cancer treatment in the first waves of the pandemic saw significant disruptions to their care.

At some point in 2020, most or even all forms of cancer therapy were canceled or delayed in various corners of the world. This included chemotherapy, surgery, radiation therapy, immunotherapy, and more.

In May 2020, in the United States, an overwhelming 79% of cancer patients in active treatment reported a delay in their care. Mexico saw a postponement of at least 50% of cancer surgeries. In Iran, pediatric cancer patients and their families predominantly felt that healthcare institutions largely prioritized COVID-19 prevention over cancer care.

Treatment Modifications

One study suggested that the COVID pandemic influenced the type of treatment that some cancer patients received. At the beginning of the pandemic, when not much was known about the virus, oncologists from 28 countries reported feelings of hesitation over which treatments were most suitable for their patients.

They were reluctant to give immune checkpoint inhibitors or chemotherapy to their patients for fear of weakening their immune systems and making them more susceptible to the virus. Another study involving 282 cancer patients in New York City confirmed that 56.4% received modified treatment due to the pandemic.

As the pandemic progressed, doctors felt more comfortable continuing these types of anticancer therapy with their patients. Immune checkpoint inhibitors have since been declared safe for cancer patients who are COVID-positive.

Cancer Trials

One more aspect of cancer care that was affected by the pandemic is cancer clinical trials. They were largely postponed or canceled during the first half of 2020 for two main reasons:

  • Reducing COVID-19 exposure in hospitals and other healthcare institutions.
  • Diverting research resources to mitigate the pandemic, learn more about the virus itself, and develop a COVID vaccine.

Canadian healthcare institutions went to great lengths to ensure their ongoing open cancer trials continue. New patients couldn’t be enrolled in these trials, and the activation of new trials was on hold, but the existing trials continued as normal.

Even though canceling or delaying clinical cancer trials was causing significant damage to cancer research, oncologists felt that it would be irresponsible of them not to prioritize researching the COVID pandemic first and foremost.

However, this, too, like all other ways COVID has affected the cancer community, will have a lasting impact.

Consequences

The changes in cancer care that COVID brought about were all but desirable. Even though health authorities have been working hard to ensure people are getting back on track with the screenings and treatments the virus disrupted, many of those affected by this disruption still feel the consequences.

  • Lower cancer incidence

Because of the delayed or canceled screenings, the number of new cancer cases in 2020 is lower than it would have been without the pandemic. There was a 46% drop in the number of diagnoses of the six most common cancers (breast, lung, colorectal, stomach, and esophagus) in the United States between March 1 and April 28, 2020, compared to the same time the previous year. The same reports are coming in from other countries as well.

In many patients, this delayed cancer diagnosis could cause a worse prognosis. Undiagnosed and untreated cancer can metastasize and spread, causing more damage to the body.

  • Increased number of preventable cancer deaths

With fewer screenings and a significant delay in cancer treatments, there could be a notable increase in advanced-stage cancers and the number of cancer-related deaths that could have been prevented worldwide.

Even though scientists are still compiling data on the full impact of this issue, it is evident that the reallocation of resources in order to deal with COVID-19 directly contributed.

  • Feelings of fear and anxiety

Cancer patients and survivors are already under great stress due to their illness, and the disruption caused by COVID-19 has only added fuel to this fire. Anxiety about becoming infected with a deadly virus or losing a loved one because of it could be severely detrimental for those already weakened by cancer.

Cancer patients have suddenly found themselves needing to choose between staying at home to reduce their risk of COVID exposure but not receiving the care they need or continuing with their cancer treatments, despite this risk.

There are no easy answers to these problems, and many people have suffered because of them.

Even cancer survivors, who are still managing the effects and side-effects of their treatments, have been impacted by this pandemic to a certain degree.

Oncology Reorganization

Despite the problems COVID-19 caused for cancer care and cancer communities, oncology centers strived to be proactive and do what they could to improve their situation.

Various institutions implemented new ways of providing support for their patients in light of the pandemic. Some adjusted their staff rotations and patient schedules to ensure patients got the care they needed around the clock. Others set up temporary clinics in community centers, churches, and other public spaces where people could get screenings without fear of exposure or infection.

Telemedicine

What most centers had in common was the liberal use of telemedicine to provide remote support. This practice has been around for a while but was not used as much before the pandemic.

Telemedicine, telehealth, or digital health includes any practice that uses electronic information and telecommunication technologies to provide clinical healthcare from a distance. This can be anything from consulting with patients over the internet, videoconferencing, or using mobile devices for data transfer.

This technology helped cancer centers manage their patient loads even when they were short-staffed due to COVID-19. It was also a way to monitor patients and ensure they were recovering as expected, even when that meant sending them home with instructions for self-care until their next visit.

The biggest benefit telemedicine provides to cancer centers is the ability to encourage preventative care in those who may not have been able to get outside or overcome their anxiety enough to go through with treatment.

The most important thing for cancer centers and patients is that prevention, early detection, and prompt care are ensured around the clock. Telemedicine makes this possible in many cases when it would otherwise be logistically impossible or too expensive for one patient at a time.

This technology has received much praise from the cancer community. People see it as a positive step forward for their healthcare and feel there is potential to improve even more. Research suggests that 80% of cancer patients want to see more of this type of care in the future, even when the pandemic subsides.

Emphasis on Mental Health

The COVID-19 pandemic has put a significant amount of pressure on cancer patients and survivors, which is why mental health care has been emphasized so much.

Mental health is important to consider in any situation with a serious illness, but it can be particularly challenging during the COVID-19 pandemic due to increased stress levels. This fact became increasingly clear when certain psychosocial issues began cropping up among cancer patients.

All this extra pressure on the mental health of cancer survivors and their families can profoundly affect an individual’s need for care in all areas, including physical healthcare.

Telemedicine has enabled cancer centers to provide this kind of support without the need for in-person visits.

The increased attention on mental health has helped reduce anxiety, depression, and other related issues by allowing patients to consult with healthcare providers remotely.

Lessons Learned

The COVID pandemic was a tremendous challenge for the cancer community. The changes it caused in oncology care, patient support, and how people interact with their providers are significant enough that they will be felt even after this pandemic is over.

Some of the most powerful lessons the entire healthcare ecosystem learned from the pandemic include the importance of adaptability, proactive care, and telemedicine.

The need to constantly adapt has proven itself over the past two years as healthcare organizations have had no choice but to change their business model to continue providing quality patient support during this time of crisis.

Preventative care is another major lesson learned during the pandemic. It’s not enough to just treat patients after they become sick – more emphasis needs to be put on prevention and early detection so that cancer is never allowed to get out of hand in the first place.

The use of telemedicine has come a long way since COVID-19, but there are still many improvements that can be made. There is a strong demand for more telemedicine options in the cancer community, which will only grow once COVID-19 has passed.

Clinical Trials

Another benefit of COVID-19 was the overhaul of how clinical trials are conducted. Due to the urgency of the pandemic, the FDA allowed for accelerated approval of new COVID vaccines. This was accompanied by a streamlining of how clinical trials are run to make them faster and more efficient.

The agencies responsible for supervising these tests also worked together better than ever during COVID-19. They were able to create standards that could be used again in the future, as well as methods to improve testing that will hopefully be implemented in clinical trials for other drugs and therapies.

More importantly, COVID-19 was a wake-up call for many people who had never thought about taking part in medical research before.

Research is a major factor in how cancer centers, drug companies, healthcare providers, and patients can learn to manage their resources better and improve preventative care options. The more people interested in being part of this process from an early stage, the faster we will be able to find the answers to our most important questions.

Conclusion

The overall effect of COVID-19 on the world of cancer care has been massive. The changes that have occurred are so great that it’s hard to imagine what things were like before the pandemic started or how much work has gone into keeping this community afloat for the past two years.

There will certainly be even more lessons learned as time goes on and COVID-19 finally comes to an end. For now, cancer clinics and their staff are putting in all the effort they can just to keep up with the demand for services as patients continue to pour in every day.

The future of oncology care is still unknown. More data is yet to be uncovered about how COVID-19 has impacted the cancer community and how things will be different when it fades away.

For now, all we can do is keep fighting. Consider donating to one of our active cancer-fighting campaigns. Your support could impact progress in cancer care, survival and the quality of life for patients diagnosed with cancer.

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