Cancer in COVID

This pandemic has exposed the weaknesses and lack of resilience of healthcare systems and these flaws have had major consequences for cancer care and cancer patients.

The COVID-19 pandemic has affected health care services in many dimensions: from interruption of regular patient flow to cancer care facilities and the overwhelming of health care resources, to the implementation of extra protective measures and social distancing with increased utilization of telehealth services.  Additionally, despite cancer patients need continuous care and cannot afford to have deferment of diagnostic tests or therapeutic interventions, oncologists around the world have started changing their daily practice to limit cancer patients’ exposure to COVID-19, potentially very risky or even fatal.

This pandemic has exposed the weaknesses and lack of resilience of healthcare systems and these flaws have had major consequences for cancer care and cancer patients. Crucial attention is needed, not only to restore cancer care delivery but to build improved systems, processes and infrastructure as long-term norm and to be better prepared to fight the next crisis.

Will there be an explosion of late-stage cancer after the pandemic?

The COVID-19 pandemic posed critical challenges to current oncology care and practices including late diagnoses, delayed anti-cancer treatment, and stalled clinical trials. In response, healthcare systems are rapidly reorganizing cancer services to ensure that patients continue to receive essential care while minimizing risk of exposure to SARS-CoV-2 infection.

Most of the cancer centres in our collaborative initiative reported a decrease in number of cancer patients during the pandemic except Brunei, Iran and Taiwan. This could be due to a decrease or deferment in follow up appointments, but as COVID-19 continues to impact nearly all aspects of cancer care, most of the countries also saw a troubling drop in new cancer diagnoses since the pandemic began. This observed drop follows a similar tendency with the 46% decrease in the diagnoses of the six most common cancer types – breast, colorectal, lung, pancreatic, gastric and oesophageal cancers during the COVID-19 pandemic at Dana Farber Cancer Institute. Similar situation was observed in European Union, United States of America, United Kingdom, Saudi Arabia, United Arab Emirates, Greek, India, and Morocco .

Cancer prevention and screening services are important components of national cancer strategies, but these were considered as non-essential during the crisis. During this pandemic, approximately 65% institutions in our survey delayed or suspended their cancer prevention and screening services to prevent the transmission of coronavirus infection. This in tandem with what happened globally as, during the early stages of the pandemic, major medical professional organisations such as the U.S. Center for Disease Control and Prevention recommended that cancer screening and other health prevention services should be postponed unless the risks outweighed the benefits.

Operations and Finance

Apart from challenges in cancer care delivery, the COVID-19 pandemic has affected the operations and finances of many cancer centres. Workload was affected and reduced partly because of intentional rescheduling of patients but also partly due to fear of patients in seeking treatment for fear of being infected, especially since patients with cancer could be at an elevated risk of COVID-19 severe infection and mortality (Shankar et al., 2020). On the other hand, several institutions highlighted the additional need to allocate staff in COVID-19 specific wards, which disturbed the human resource management

Will telemedicine and technological innovations revolutionize cancer care?

A positive aspect that has emerged during the pandemic is the deployment of telemedicine to support cancer care across Asia. Telemedicine and tele-health-based interventions have emerged as reasonably practical solutions to these impediments in the delivery of care to cancer patients. Since most of the regular face-to-face visits for cancer patients have either been postponed or cancelled, tele-health-based interventions allow oncologists to take care of their patients remotely and monitor their progress.

Will Virtual conferences continue, at least in part, after the pandemic?

With in-person cancer conferences curtailed during the Covid-19 pandemic, oncologists have struggled to continue the development and training they have historically relied on these meetings for. Face-to-face meetings have previously provided opportunities to interact with colleagues and experts, leading to many research and academic collaborations.

The worldwide impact of the pandemic has promoted the introduction and enhancement of virtual conferences, providing ample learning opportunities through participation to symposia and major conferences, while also allowing opportunities to collaborate through various smaller web-based meetings.

How do we prepare for the next pandemic or International emergency as an International Community?

The COVID-19 pandemic has created many unprecedented and unexpected challenges while also revealing opportunities to improve patient access to high-quality cancer care and research. COVID-19 vaccines have been discovered and are accessible to healthcare professionals as experienced by NCC Singapore and an aggressive vaccination program in the institution. There is a need for the participating countries in the Asian region to provide a roadmap of actions with the aim to help improve access to affordable and equitable care and clinical research. Streamlining excessive and unnecessary regulatory requirements in practice and research, as well as achieving improved outcomes for patients with cancer are also acute requirements that can be started to be addressed by participating institutions in the region.

To re-establish cancer care following the COVID-19 pandemic, oncologists must remember the lessons learned from this pandemic and overcome the obstacles encountered in providing cancer care services. Clinicians, researchers, and academicians should be encouraged to share and publish their knowledge and findings on the impact of pandemic on cancer patients.

(The research paper has been co-authored by Dr Abhishek Shankar, Assistant Professor in Department of Radiation Oncology at Lady Hardinge Medical College & SSK Hospital, Delhi; Associate Editor, APJCP; Editor in Chief, APJCC, and Founder Secretary of Indian Society of Clinical Oncology. He tweets with @ShankarAbhishek).

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