In the pandemic’s third year, we are beginning to discern the total picture of Covid-19’s damage. Beneath the coronavirus’s own staggering death toll and the suffering it has inflicted lie many layers of collateral damage. One of the largest of these is Covid’s disruption to cancer prevention and care.
Cancer patients are among the most vulnerable to catching Covid, and if exposed they’re much more likely than other people to end up in the hospital or to die. They’re also among the least likely to benefit from vaccines, because cancer treatment weakens the immune response.
This is why, as Welela Tereffe, the chief medical executive at the University of Texas MD Anderson Cancer Center, puts it, “cancer patients rely on everybody else to also do their part” to keep the virus in check.
But everyone did not do their part to get vaccinated and help slow the coronavirus’s spread. What’s more, the waves of infections put pressure on hospitals and their employees, disrupted routine screenings, and sent cancer centers scrambling to ensure a continuum of care.
All this has come at great cost to the physical and emotional well-being of cancer patients and their families — something that came into stark relief for me in October, when my father-in-law went into the hospital in severe pain and walked out two days later as a pancreatic cancer patient.
A doctor delivered the bleak diagnosis the morning after my father-in-law had spent the night in a hallway — the hospital was overrun with Covid patients — with no family members beside him to help absorb the blow.
The pandemic has also subjected cancer patients to many daily indignities. Prescriptions have been difficult to fill when pharmacies have been closed due to staff shortages. Wait times have been long for appointments with counselors who can help patients process a difficult diagnosis. Tests and procedures have been delayed because resources are stretched.
Covid’s most quantifiable toll on cancer care has been its effect on screening. In just the first half-year of the pandemic, from January to July of 2020, 10 million screening tests were missed, according to a recent report from the American Association for Cancer Research. New cancer diagnoses, in turn, dropped 13% in 2020, according to a recent study of the Veterans Affairs health-care system.
And the backlog persists. Some people remain unwilling to go in for preventive doctor visits because they’re worried about the risk of exposure to Covid. And once a routine colonoscopy or mammogram has been delayed, doctors know, it’s very easy to keep putting it off. The danger is that when people finally go in for missed screenings, their tests will show more advanced cancers.
The question now is whether the health-care infrastructure will be robust enough to handle a wave of new cancer patients. Covid has depleted the health-care workforce. In the past two years, about 20% of American health-care workers left the field, according to Morning Consult.
This attrition will have an outsized effect on the health of patients in the long run, says Tatiana Prowell, an associate professor of oncology at Johns Hopkins Medicine. With no fast way to replenish the workforce, Prowell worries her patients will ultimately be worse off for years to come.
To rebuild support systems for cancer prevention and treatment, the oncology community should build on some of the practices it adopted during the pandemic, including more patient-centered approaches that made it easier for more people to access high-quality care. During Covid, telemedicine became more widely accepted for cancer care in many places. Clinical trial participants were allowed to sign consent forms remotely, get routine tests and scans in their own neighborhoods, check in with their oncologists virtually, and have experimental drugs shipped directly to their homes.
Such small changes can add up to a big difference in the day-to-day lives of cancer patients and their families. Telemedicine meant that in his final weeks, my father-in-law didn’t spend his limited energy on getting to a doctor’s office, and his whole family could be with him to hear from his oncologist or palliative-care team.
Changes like these can improve access to health care for the poor, for people living in rural areas and for communities of color. When a cancer center is a few hours, or even a plane ride, away, or a patient lacks child care or can’t miss work, good care is too often out of reach.
After the pandemic subsides, the cancer community might be tempted to fall back into old habits. Hospitals and cancer centers should not only resist that urge, but they also should keep pushing for more and better ways to democratize access to care.
Revitalizing the health-care infrastructure is a necessary part of that goal — and will help guarantee that future patients don’t pay the price of the pandemic.
Bloomberg
