COVID-19 and cancer: reflections 2 years into the pandemic
Article information
Abstract
The COVID-19 pandemic, which emerged in the light of day toward the end of 2019, has changed almost every field of health care basically, and oncology is no exception. After reflecting on events of the past 2 years, it becomes evident that while the pandemic has put several difficulties in the way of cancer diagnosis, treatment, and research, it has also brought about a few positive changes and once again highlighted how strong the global cancer care community is.
EFFECTS ON CANCER CARE AND DIAGNOSIS
One of the most immediate effects of coronavirus disease (COVID-19) on cancer was disrupting routine healthcare services. Subsequently, due to the lockdowns, social distancing measures, and reallocation of health resources to managing patients infected with COVID-19, there is a resulting backlog in elective procedures that had to be postponed, including cancer screening and non-urgent surgeries. That essentially means diagnosis and treatment for these conditions were delayed, with long-term consequences; studies show that during the peak periods of the pandemic, cancer diagnoses dropped significantly [1]. A 2020 report from JAMA Oncology [2], for example, revealed that there was a drastic decline in the diagnosis of six common cancers during the first months of the pandemic. As such, this means that this delay will then be followed by stage shift—diagnosis of cancers at higher stages, with poorer outcomes. Further, the detection process was delayed since most patients, due to the fear of getting the virus, stopped going for treatment.
IMPACT OF THE PANDEMIC TO THE CANCER TREATMENT
Many changes have been caused by the pandemic in the treatment of cancer. Many hospitals and clinics became overwhelmed with COVID-19 cases and thus prioritizing was done; cancer therapies were mostly postponed or changed. Chemotherapy, radiation, and surgical interventions have often been postponed, particularly in the first months of the outbreak when the burden of COVID-19 was at its worst. Results from a global survey conducted by European Society for Medical Oncology in 2020 documented more than 50% of patients facing delays in treatment, which differed tremendously depending on the region and local COVID-19 burden [3]. Besides the delays to treatment, the pandemic brought exceptional challenges for cancer patients whose immune systems were already weakened by their disease or its treatment. These patients had a higher risk of severe COVID-19 complications and difficult decisions about whether to continue or modify treatment regimens. It therefore called for a balancing act to ensure minimal exposure to COVID-19 while continuing cancer treatment, yet such individualized treatment decisions had to be made in the face of limited data about the interaction between COVID-19 and cancer [4].
INNOVATIONS AND ADAPTATIONS IN CANCER CARE
These hardships notwithstanding, the pandemic has expedited several innovations in cancer care. Because in-person care was significantly curtailed at the height of the pandemic, the rapid uptake of telemedicine has indeed allowed for the continuity of a wide range of cancer care activities, from consultation to follow-up visits to even some varieties of supportive care. Telemedicine went from niche offering to cornerstone in oncology, allowing patients to go on getting care while lessening their exposures to the virus. This change in behavior, accelerated by the pandemic, is likely here to stay. Indeed, most institutions plan on continuing the use of telemedicine as part of their cancer care delivery even when this pandemic resolves [5]. The urgency of the pandemic has also brought into being an extent of collaboration and data sharing among researchers, clinicians, and pharmaceutical companies that was unprecedented. Based on messenger RNA (mRNA) technology, development of COVID-19 vaccines opened new avenues for cancer immunotherapy. The successes of these vaccines renewed interest in mRNA-based cancer treatments, which could revolutionize the field of oncology in the upcoming years.
CANCER CARE BEYOND THE PANDEMIC
The long-term impact of the pandemic on cancer care will have to be taken up in the future also. Catch-up in delayed screenings and treatments; such patients who might have been missed during the COVID-19 pandemic should be quickly diagnosed and treated. Further, studies are required to understand the overall impact of COVID-19 on cancer patients, particularly those who suffered from COVID-19 and survived [6].
Especially, the pandemic has evidenced the need for more resilient healthcare systems that are able to adapt to future crises without taking away from the care of vulnerable populations like cancer patients. It requires greater investments in telemedicine infrastructure, stockpiling of personal protective equipment, and guidelines on cancer management during pandemics.
Psychologically, the COVID-19 pandemic has also powerfully affected cancer patients and their families. The fear of contracting the virus, coupled with anxiety over possible delays in cancer treatment, could be considered a perfect storm of stress for many patients. In addition, social distancing has further added to this sense of isolation, increasing feelings of loneliness and depression, particularly in those already emotionally shaken by the diagnosis of cancer [7].
The pandemic disrupted support systems, in-person support groups, and even counseling sessions, thereby nudging many patients towards virtual platforms for their emotional and psychological support. While such online resources were quite literally a godsend in this regard, they are not altogether able to replace the comfort from face-to-face interactions. The shift also highlighted the problems of digital accessibility because some of these patients could not access virtual support due to limitations in access to the internet or digital literacy.
The new challenges presented by the pandemic meant that many healthcare providers had to quickly adapt to using telemedicine in integrating psychosocial care. More than ever, the need for a holistic approach in cancer care and to attend to mental health became very loud during this time period.
IMPACT ON CANCER RESEARCH AND CLINICAL TRIALS
The pandemic was a hard blow to research in cancer and clinical trials. Numerous trials were in process but were suspended or postponed because research institutions and hospitals shifted attention to COVID-19 studies. The pace of new trials in recruitment became very slow, while some were brought to an absolute halt due to the development of logistic difficulties and concerns for the safety of patients involved [8].
It has delayed the progress of new cancer therapies by months or even years, which quite possibly will set back the development of life-saving treatments. The challenges of conducting clinical trials during a pandemic led to a reassessment of how such trials should be designed and conducted. Decentralized trials—those that use telemedicine and local healthcare providers to minimize how much time patients spend at big research centers took center stage as a more flexible and patient-friendly approach to clinical research.
Moreover, the pandemic brought home with it the realization of the need for adaptive designs in clinical trials, which would allow modifications in trial protocols subject to emerging data. These innovations are driven by necessity and may hence conduct more efficient and patient-centered research practices in the post-pandemic era.
ROLE PUBLIC HEALTH INITIATIVES AND POLICY CHANGES PLAY
The COVID-19 pandemic brought to the fore how public health programs and policy decisions could lessen such blows on cancer treatment. Indeed, governments and healthcare organizations around the world did take several steps to ensure that the care of cancer patients was not disrupted—from prioritizing vaccination against COVID-19 for cancer patients to institutionalizing procedures for the safe management of cases during the pandemic [9].
These were supplemented by public awareness campaigns with regard to the continuity of attendance of people at cancer screening and searching for medical care for symptoms that are concerning, even during the pandemic. How far these worked out well varied from region to region, depending principally on health infrastructure, public trust in the health system, and the degree of severity of the pandemic locally.
Key to the future of cancer care will be policy changes, especially those related to healthcare funding and resource allocation. The pandemic has exposed manifold deficiencies in healthcare systems that have to be changed if there is to be adequate preparation for cancer patients in any future public health emergency. These include adequate funding for cancer research, expanding access to telemedicine, and preparation plans for emergencies with a priority for vulnerable populations.
LESSONS LEARNED AND THE WAY AHEAD
These lessons learned over the past 2 years will be so important in really shaping what the future of cancer care will look like as the world continues grappling with the ongoing, ever-changing effects of the COVID-19 pandemic. It stressed flexibility, innovation, and resilience against unprecedented challenges. Much more than this, it has put forward working together within the oncology community itself and among the providers of health care, researchers, and makers of policy [10].
Moving into the future, there needs to be building on that momentum developed during the pandemic while also addressing gaps that unmasked. This would include access to cancer screening and treatment for all people particularly those of underserved populations and further innovating within new models of care wielding technology to advance patient outcomes. Finally, some further research into the impact of COVID-19 on long-term effects in people living with cancer will also be very important to appreciate and minimize lasting effects of the pandemic in this vulnerable population [11].
Taken together, while the pandemic has no doubt brought many challenges to cancer care, it has also accelerated innovation and adaptation that will benefit patients for years to come. Unless the oncology community really learns from the past 2 years’ experiences, and makes the needs of cancer patients a continued priority, it will not come out stronger from this crisis. This goes on to prove more than anything else that the resilience of the healthcare providers, researchers, and patients in this fight for a cure against cancer never backed off, even in the wake of a global pandemic.
CONCLUSION
Though the COVID-19 pandemic has posed considerable challenges in the administration of care for cancer, it really catalyzed innovation and adaptations within the oncology community. The lessons that have been learned during this period will no doubt help carve out the future of cancer care through improvements in patient outcomes and healthcare systems worldwide. Further, as we go on navigating the ongoing effects of the pandemic, we have to be vigilant about giving support to cancer patients and pressing forward in fighting this scourge.
Notes
No potential conflict of interest relevant to this article was reported.
FUNDING
None.