Treating cancer in the COVID-19 era: How have things been affected?

Many of the consequences of SARS-CoV-2 arise not from the virus itself, but from our response to it. Cancer may be a significant source of this.

Writer: Dan Jacobson
Editor: Jonjo Cordey
Artist: Lucie Gourmet

Whilst there are a multitude of ways to measure the worldwide impact of SARS-CoV-2, one of the most telling approaches is to calculate the number of ‘excess deaths’ during this pandemic. This measure refers to the increase in deaths compared to the same period in previous years. Although many of these can be directly attributed to COVID-19 itself, a significant number are not, and are instead the result of our response to it. 

Cancer may end up a key contributor of excess deaths for a variety of reasons, including delayed diagnosis of new cases due to cancelled referrals and limited access to therapy; symptomatic of the enormous stress put on healthcare practices this year. Early diagnosis has always been essential for combating cancer. A recent review suggested that even a four week delay in treatment can lead to increased mortality across multiple cancer and treatment types. 

This early diagnosis has been enabled by a focus on researching early stages of cancer, alongside public encouragement to seek out regular cancer screenings, millions of which may have been missed due to COVID-19. The drive to ‘Save The NHS’ by not supplying additional burdens undoubtedly prevented individuals from being both treated and diagnosed, with devastating consequences.

In April, researchers at UCL’s Institute of Health Informatics used electronic health records to estimate the effects of coronavirus’ disruption of cancer treatment. They estimated an additional 18,000 deaths amongst cancer patients, with over 6,000 in newly diagnosed patients over the following 12 months. This was attributed to a combination of late diagnosis, delayed chemotherapy, cancelled operations, and increased risk of COVID-19. According to Public Health England, weekly cancer-associated excess deaths increased by between 10 and 20% during the first month of lockdown.

Following her preprint publication, Dr Alvina Lai, who led the study, stated that “it [is] vital that these [cancer] patients are recognised as being vulnerable and that their care is managed appropriately”. During April, Dr Lai also reported a decrease in chemotherapy attendance of 60%, and a 76% decline in urgent referrals by GPs. The question therefore facing medical practitioners is how to treat patients when they are actively discouraged from turning up to medical appointments.

In addition to disruptions in cancer treatment this year, the pandemic has also triggered a paradigm shift regarding healthcare resource allocation, which will have a significant long-term effect on cancer research. Thousands of clinical and drug trials have been paused or scrapped. Millions in cancer research funding have also been lost, or diverted towards coronavirus research, with Cancer Research UK reporting cuts of up to £150 million.

From the beginning, SARS-CoV-2 was aptly described as a ‘wicked problem’ and, from lockdowns to furloughs, we have become used to talking about our collective response in terms of hindsight. However, cancer-associated excess deaths emphasise the importance of a holistic approach to the pandemic. We know that coronavirus is not disappearing, so the next step is learning to continue with it. 

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