ESMO 2020 – Expert commentary: the widespread, multifaceted impact of COVID-19 on cancer care

  • Cristina Ferrario — Agenzia Zoe
  • Oncology Conference reports
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Abdul-Rahman Jazieh is the chair of the Department of Oncology at King Abdulaziz Medical City in Riyadh, Saudi Arabia. At ESMO Virtual Congress 2020, he presented the results of a global collaborative study on the impact of COVID-19 on patient care, gathering data from 356 cancer centers across 54 countries worldwide. Here, he discusses some of the findings.

  • The pandemic affected cancer care in more than 88% of the participating cancer centers to varying degrees.
    • The impact has varied in severity from only reducing services to causing a total shutdown.
    • The reasons have also varied with the degree of estimated harms to the patients. 
  • We did analyses of the centers based on the World Bank stratification of income to low-, middle-, and high-income countries.
    • There was a more negative impact on cancer care in lower-income countries, including a lack of access to personal protective equipment (PPE), cancer medications, and cancer-specific care, as well as other medical care.
  • Our study specifically focused on the care of existing patients with cancer and not the whole continuum (i.e., prevention and/or diagnoses).
    • But almost all therapeutic modalities were affected to varying degrees, including surgery, radiation therapy, systemic therapy stem cell transplant, and palliative care. 
  • About 46% of the centers stated that more than 10% of their patients (from 11% to 99%) missed at least 1 cycle of chemotherapy.
    • The total number of missed cycles for many patients is not known.
    • These missed cycles will have detrimental effects on some patients who will have progressive disease and worse outcomes.
  • The final impact of the pandemic depends on a combination of factors.
    • Maybe because of the belief that cancer patients are a vulnerable population, 55% of the centers reduced their care preemptively as a precautionary measure.
    • However, many centers stated that their normal care was interrupted/changed because of a lack of PPE (almost 20%) and medications (almost 10%) or because of an overwhelmed system (20%).
  • I think that these figures will get better because of widespread experiences and available literature about how to respond (to the pandemic) and adjustment of the system and flow of care.
    • Some of these modifications in the care delivery process are the silver lining of the crisis because they were a catalyst and enabler of implementing virtual communication and remote care, care near patients’ home.
    • Many of these changes will persist as they are very convenient to patients and caregivers and they are cost-effective to the health care system.
  • The recovery phase is going to be a bit long because we do not know the magnitude of harm to current and future cancer patients.
    • Cancer care providers started immediately catching up with their backlog of untreated patients as a priority.
    • The health care systems have to activate their cancer screening and early detection programs to detect cancers as early as possible.
    • Public assurance about seeking help is very important to overcome patients’ reluctance to visit health care facilities out of their fear of contracting the infection.
  • Finally, we have already learned many lessons from the pandemic: always have contingency (preparedness) plans for any crisis, have an adequate stock of PPE and cancer medications, have a special track for cancer care separate from potential infectious disease track, revisit all activities done, and evaluate the need for them to be done at all or done differently. 

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