Pause in cancer treatments during COVID may cause other public health crisis
Yet another unfortunate outcome of the COVID-19 pandemic: More people with cancer are going undiagnosed and untreated.
With health and government officials focused on COVID-19, and people afraid to go to doctor's offices and hospitals for fear of catching the disease, cancer experts see a new emerging public health crisis going unnoticed which may lead to more cancer deaths.
Dr. Norman "Ned" Sharpless, director of the National Cancer Institute and former acting director of the Food and Drug Administration, is one of the experts sounding the alarm.
"Less cancer is being diagnosed but we think the incidence of cancer during this period is the same," he said in an interview with ABC News. "These cancers will eventually come to light, when they become important symptomatically, and at that point patients will have a [worse] prognosis."
Experts say the earlier cancer is detected, the more likely it will be treatable and the person will survive. Cancers diagnosed at a later stage, which experts call "upstaging," can be harder to treat and are sometimes fatal.
A National Cancer Institute model evaluating the impact of the pandemic on breast and colorectal cancer forecasts there will be 10,000 excess deaths from these two types of cancers in the U.S. over the next 10 years, peaking in the next 1 to 2 years. This is about a 1% increase in deaths over the given time span, when experts would already expect 1,000,000 deaths from breast and colorectal cancers.
"Our estimate is probably a lowball," said Sharpless, given the model's "conservative" assumptions. The analysis did not consider other cancer types, nor did it account for additional "nonlethal morbidity from upstaging," and assumed the pandemic would only interrupt regular cancer screenings for about six months.
"Ultimately, people diagnosed at a later stage will have a higher risk of not being cured from their cancer," said Dr. Jeff Meyerhardt, practicing oncologist and clinical director of the Gastrointestinal Cancer Center at Dana-Farber Cancer Institute.
According to Sharpless, the number of Americans dying from cancer has steadily gone down since 1993. The pandemic may bring this "three decade winning streak" to a screeching halt. "We are worried we will see loss of progress," he added, "Cancer mortality might go up for the first time in decades."
Sharpless admitted that postponing some cancer-related procedures was "wise and prudent" at the early stages of the pandemic. But now doctors know how to keep patients safe, and it's critical that people schedule their cancer-related care for those receiving cancer treatment, recovering, or who have yet to be diagnosed.
To make matters worse, now months into the pandemic many patients are still apprehensive about going to hospitals and clinics in fear of contracting the virus, missing critical cancer screenings, such as mammograms.
It's likely that by also avoiding regular medical visits and annual checkups, some people may miss the chance to have an unknown cancer fortuitously diagnosed, referred to as a "incidental cancer diagnoses," added Meyerhardt. Standard lab tests done in the primary care physician's office or unrelated visits to the emergency room often lead to unexpected and even life-saving cancer diagnoses.
In fact, a recent report by the Centers for Disease Control and Prevention found that emergency department visits dropped off in the 10 weeks after COVID-19 was declared a national emergency. Emergency room visits declined 23% for heart attacks and 20% for stroke. "Cancer is one sign of the problem, there is an under diagnosis across the board for a number of conditions," said Sharpless.
"Hospitals have to be innovative," he said to find new and creative ways to resume treatment that prioritize and ensure patient safety along with staff providing that care.
At the Dana-Farber Institute for example, every patient gets screened for COVID-19 symptoms the day before over the phone and upon arrival. To reduce crowding, Dana-Farber also enforced a no-visitor policy and modified appointment scheduling to reduce wait times.
All patients and staff also wear masks, Meyerhardt said.
"A lot of people are very concerned that it's a medical facility so there must be a danger to it, but the amount of protected things that are done really feel much safer than going to other settings and reduce the risk of transmission," he added.
Health care clinics and hospitals are also increasing their telemedicine capacities. The Dana-Farber institute went from nearly zero telemedicine visits before the pandemic to over 3,000 visits per week, making up about 50% of their exam practice volume in late May.
Telemedicine may be an especially important tool for cancer patients who may also suffer from other comorbidities that place them at an even higher risk of severe COVID-19 complications.
Beyond clinical care, the ongoing quest to find new cancer treatments through clinical trials has also been disrupted by the pandemic.
"The scientific community must ensure that this pause is only temporary because trials are the only way to make progress in developing new therapies for cancer… the effects of pausing research today may lead to slowdowns in cancer progress for many years to come," Sharpless wrote in an editorial.
In cases where treatment options are limited, clinical trials provide patients with the opportunity to receive a drug or treatment regimen that is still being tested. "We had some trials we couldn't continue enrolling in, which limited our ability to provide as many opportunities to patients," said Meyerhardt. But in other cases, some trials were fortunately able to continue remotely. ,With many fearing a second wave and some states reporting concerning increases in COVID-19 cases, Sharpless said, "We now have the ability to provide care for both kinds of patients so we don't swap one public health crisis for another."
But he warned that if hospitals and clinics don't rapidly resume their capacity for screenings, early detection, radiation and other proven cancer interventions, the consequences could be dire. Cancer deaths could even "go back up and go to levels we haven't seen in a while in the United States."
"We have to work this out because the virus will be with us for a while and cancer is definitely not going anywhere," Sharpless added.
Eden David, who studied neuroscience at Columbia University and is matriculating to Icahn School of Medicine at Mount Sinai later this year, is a member of the ABC News Medical Unit. Alexis E. Carrington, M.D., is currently completing her internal medicine preliminary year at Elmhurst Hospital in New York City and is a contributor to the ABC News Medical Unit.
