According to the World Health Organization, the COVID-19 pandemic has cost over five million lives to date. A recent report by The Economist suggests that the death toll could be much higher, over 20 million. Even that number, however, does not account for the many lives that will be lost in coming years to other diseases that have gone untreated or undetected during the pandemic.
As patients and people working in the cancer community well know, many essential services were disrupted by successive waves of the pandemic and many health systems still struggle to cope with backlogs and demand. Treatments have been delayed, routine screenings have been suspended, people have been unable to consult or seek care due to travel restrictions, or have been reluctant to do so out of fear of catching COVID-19.
Between March 1, 2020 and April 18, 2020, the US saw an estimated 46.4% decline in average in the number of newly diagnosed cases of six of the most common types of cancer (breast, colorectal, oesophageal, gastric, lung, and pancreatic).[1]
Other countries have been similarly affected; to list a few: the UK experienced a decrease in the number of referrals for suspected cancer of over 80% while restrictions were in place; [2] during the first wave of the pandemic, India recorded a 38% drop in pathological diagnostics, a 54% drop in the number of new cancer patients registered, a 46% drop in the number of follow-up patients and 36% drop in hospital admissions for cancer;[3] and in New Zealand, there was a 40% decline in cancer registrations compared to 2018–2019 during the national shutdown in March-April 2020.[4]
This is not because fewer people have cancer but because fewer people are coming in to get tested. At the peak of the pandemic in April 2020, screenings in the US for breast, colon, prostate, and lung cancers were lower respectively by 85%, 75%, 74%, and 56%, compared to 2019.[5] Overall, an estimated 10 million cancer screenings have been missed in the US during the pandemic and we don’t know how many have been rescheduled in a timely fashion.
The negative impact on cancer survival rates is clear. The NCI estimates that there will be almost 10,000 excess deaths from colon and breast cancer cases alone in the US over the next ten years because of delays in diagnosis. According to a study published in the British Medical Journal, “people whose treatment for cancer is delayed by even one month have in many cases a 6 to 13% higher risk of dying.”[6] In fact, the British Medical Journal estimated that cancer-related deaths could rise at least 20% as a result of the pandemic.[7]
I could go on, but the disturbing fact I wished to highlight is that while this is almost old news to anyone working in the cancer space – and the situation is hardly specific to cancer, but also affects people with heart disease and many NCDs – the issue is hardly covered by mainstream media beyond the occasional article or news segment.
We can only speculate on the reasons for this lack of coverage as well as for the absence of any substantial public debate about how to mitigate the impact of COVID-19 on cancer control. It may be due to an overwhelming focus on the immediacy of COVID-19, with repeated waves of infections and difficulties surrounding the vaccine rollout; there may the idea that the general public and even government authorities don’t have the bandwidth to manage another, more subtle public health crisis; or it may because there is a sense of powerlessness, that little can be done currently to address the many other health consequences of the pandemic.
No matter the reason, the cancer community needs to make its voice heard. We need the general public to know about the risks of delayed routine screenings and we need health authorities to take necessary and manageable measures to address the situation and ensure that the incredible advances we are seeing in cancer control are not curtailed further by the pandemic.
It is possible – without undermining efforts to curb the spread of COVID-19.
We reached out in June to one of UICC’s members in India, Tata Memorial Hospital, after the country had just experienced a brutal second wave due to the Delta variant that made worldwide headlines. Supriya Chopra, MD., Professor in Radiation in Oncology, told me about how lessons learned from the first wave led to the rapid adoption of more innovative ways of delivering care that allowed them to continue treatment and maintain levels of screening. And with cancer wards kept well separate from COVID-19 wards, patients also felt safe to return.
In fact, care centers and cancer organizations around the world showed extraordinary resilience and capacity for adaptation. Several were able to work with their governments to ensure that people had access to reliable information and services or promoted new programs that brought cancer care to underserved populations even as the pandemic raged.
The pandemic has silver linings and opportunities. There is a greater focus on health and in particular patient-centered care. [8] We have seen greater international cooperation, improvements in regulatory procedures, and the potential for more streamlined clinical trials, [9] as well as scientific advances in terms of cancer vaccines, therapies, and drugs. [10] These developments can assist in mitigating the current crisis and help prepare for a future one.
It is therefore not a question of competing with COVID-19 or saying that cancer must take precedence. This is about drawing attention to a looming crisis that can be managed more efficiently given current resources to make health systems more resilient and more equitable. Governments can do so by developing and implementing a national cancer control plan that addresses their needs, with their resources, and make sure that cancer care is part of a health scheme that provides coverage universally.
So that in the next pandemic we can continue to address the vital health needs of all populations and prevent an even greater crisis from occurring later as a consequence of inaction. So that we can again work towards ensuring that no one dies of preventable and treatable cancer.
References
[1] Cooney, E. “New cancer diagnoses fell sharply as the coronavirus pandemic first hit”, STAT, 4 August 2020. Online. Last accessed on November 20, 2021.
[2] Sud, A. et al. “Effect of delays in the 2-week-wait cancer referral pathway during the COVID-19 pandemic on cancer survival in the UK: a modelling study”, The Lancet Oncology, 2020; 21: 1035–44. Online. Last accessed on November 26, 2021.
[3] Ranganathan, P. et al. “Impact of COVID-19 on cancer care in India: a cohort study”, The Lancet Oncology, 2021 Jul; 22(7): 970–976, DOI: 10.1016/S1470-2045(21)00240-0. Last accessed on November 26, 2021.
[4] Gurney, J. et al. “The impact of the COVID-19 pandemic on cancer diagnosis and service access in New Zealand–a country pursuing COVID-19 elimination”, The Lancet Regional Health Wester Pacific, March 22, 2021 DOI:https://doi.org/10.1016/j.lanwpc.2021.100127. Last accessed on November 26, 2021.
[5] McNulty, R. “Cancer Care Delays in COVID-19 Could Lead to Higher Morbidity, Mortality”, American Journal of Managed Care, 22 October 2020. Online. Last accessed on November 26, 2021.
[6] Cohort study, ‘’ Every month delayed in cancer treatment can raise risk of death by around 10%’’, British Medical Journal, November 4, 2020. Online. Last accessed on November 26, 2021.
[7] Wise J. Covid-19: Cancer mortality could rise at least 20% because of pandemic, study finds. BMJ 2020;369:m1735. Online. Last accessed on November 22, 2021
[8] Gupta, A., P. Cuff , K. Dotson-Blake, J. Schwartzberg, C. Sheperis, and Z. Talib. 2021. “Reimagining Patient-Centered Care During a Pandemic in a Digital World: A Focus on Building Trust for Healing.”, NAM Perspectives. Commentary, National Academy of Medicine, Washington, DC. https://doi.org/10.31478/202105c. Last accessed on November 23, 2021
[9] Flaherty, Keith T., et al. “Rethinking Cancer Clinical Trial Conduct Induced by COVID-19: An Academic Center, Industry, Government, and Regulatory Agency Perspective”, Cancer Discovery, Vol. 11, Issue 8, pp. 1881-1885, American Association for Cancer Research. https://doi.org/10.1158/2159-8290.CD-21-0850. Last accessed on November 23, 2021
[10] Editorial, ” COVID-19 and cancer: 1 year on”, The Lancet Oncology, Vol. 22, Issue 4, p. 411, 1 April 2021. https://doi.org/10.1016/S1470-2045(21)00148-0. Last accessed on November 23, 2021.
Featured Image: Dr. Cary Adams is being interviewed during the 2021 World Cancer Leaders’ Summit ‘Driving innovation to advance cancer control equitably,’ held virtually around the world, October 25-26, 2021.
