Another unfortunate outcome of the COVID-19 pandemic: more and more people with cancer remain undiagnosed and untreated.
With health and government officials focused on COVID-19, and people who are afraid to go to doctors’ offices and hospitals for fear of contracting the disease, cancer experts see a new nascent health crisis go unnoticed, which could lead to higher deaths from cancer.
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 who are sounding the alarm.
“Less cancer is diagnosed, but we believe that the incidence of cancer is the same during this period,” he told ABC News. “These cancers ultimately come to light when they become symptomatically important, and at that point the patients will [worse] forecast. “
Experts say that the sooner cancer is detected, the greater the likelihood that it will be treatable and the person will survive. Cancer diagnosed at a later stage, which experts call “upgrading,” can be more difficult to treat and sometimes deadly.
A National Cancer Institute model evaluating the impact of a pandemic on prognosis of breast and colorectal cancer will occur in 10,000 deaths from these two types of cancer in the United States over the next 10 years, peaking in the next 1-2 years. This is about 1% more deaths over the period when experts already expected 1,000,000 deaths from breast and colorectal cancer.
“Our estimate is probably base,” Sharpless said, given the “conservative” assumptions of the model. The analysis did not take into account other types of cancer and did not take into account the additional “non-lethal incidence from outgrowth”, and suggested that a pandemic would interrupt only regular cancer screenings for about six months.
“Ultimately, people who are diagnosed at a later stage will have a higher risk of not being cured of cancer,” said Dr. Jeff Meyerhardt, a practicing oncologist and clinical director of the Cancer Center of the Gastrointestinal tract at the Dana-Farber Cancer Institute.
According to Sharpless, the number of Americans dying of cancer has been steadily declining since 1993. A pandemic could lead to this “three-decade victory streak” with a terrifying stop. “We are worried that we will see a loss of progress,” he added, “for the first time in decades, cancer mortality may increase.”
Sharpless acknowledged that putting off some cancer-related procedures was “wise and reasonable” in the early stages of the pandemic. But now doctors know how to ensure the safety of patients, and it is very important that people plan treatment for cancer, for those who receive treatment for cancer, recover or who have yet to be diagnosed.
To make matters worse, now, just a few months after the outbreak of the pandemic, many patients are still afraid to go to hospitals and clinics for fear of contracting the virus by skipping critical screening examinations such as mammography.
It is likely that by avoiding regular visits to the doctor and annual examinations, some people may miss the chance to accidentally make a diagnosis of an unknown cancer called an “accidental cancer diagnosis,” Meyerhardt added. Standard laboratory tests performed in the primary care room or unrelated visits to the emergency room often lead to unexpected and even salvage cancer diagnoses.
In fact, recent report The Centers for Disease Control and Prevention found that emergency room visits stopped 10 weeks after COVID-19 was declared a national emergency. The number of emergency visits decreased by 23% for heart attacks and 20% for stroke. “Cancer is one of the signs of the problem, a number of conditions are diagnosed in all directions,” Sharpless said.
“Hospitals need to be innovative,” he said, to find new and creative ways to resume treatment that prioritize and ensure patient safety along with the staff providing this care.
For example, at the Dana-Farber Institute, each patient is screened for COVID-19 symptoms the day before by phone and upon arrival. To reduce the number of visitors, Dana Farber also introduced a no-attendance policy and changed the meeting schedule to reduce waiting times.
All patients and staff also wear masks, Meyerhardt said.
“Many people are very concerned that this is a medical facility, so there should be a danger to it, but the amount of protected things that are done really feel much safer than visiting other facilities and reduce the risk of transmission,” he added. ,
Medical clinics and hospitals are also expanding their telemedicine capabilities. The Dana-Farber Institute moved from near-zero telemedicine visits to a pandemic to more than 3,000 visits per week, accounting for about 50% of their total exam practice at the end of May.
Telemedicine can be a particularly important tool for cancer patients who may also suffer from other concomitant diseases that put them at even greater risk of serious complications of COVID-19.
In addition to clinical care, the pandemic has also thwarted the ongoing search for new cancer treatments through clinical trials.
“The scientific community must ensure that this pause is temporary, because trials are the only way to make progress in developing new cancer treatments … the consequences of the suspension of research today can slow the development of cancer for many years to come,” Sharpless writes in editorial,
In cases where treatment options are limited, clinical trials give patients the opportunity to receive a drug or treatment regimen that is still being tested. “We had several trials in which we could not continue registration, which limited our ability to provide as many opportunities as possible for patients,” Meyerhardt said. But in other cases, some trials, fortunately, could continue remotely. “Many people fear the second wave, and some states report an increase in the number of cases of COVID-19,” Sharpless said: “Now we have the opportunity to help both types of patients, so we cannot change one public health crisis for another.”
But he warned that if hospitals and clinics were not able to quickly renew their capabilities for screening, early detection, exposure, and other proven cancer interventions, the consequences could be dire. Cancer mortality may even “return to a level that we have not seen in the United States.”
“We have to solve this because the virus will be with us for a while, and the cancer will definitely not go anywhere,” Sharpless added.
Eden David, who studied neurology at Columbia University and enters the Icahn School of Medicine at Mount Sinai at the end of this year, is a member of ABC News Medical Department. Alexis E. Carrington, MD, is currently completing his first internal medicine training course at Elmhurst Hospital in New York and is a member of the ABC News Medical Department.