Cancer care takes hit during pandemic
The coronavirus pandemic has negatively impacted the treatment and health of cancer patients across the globe, researchers said Tuesday at the San Antonio Breast Cancer Symposium.
As hospitals and health care facilities responded to the COVID crisis, cancer patients experienced wide-ranging disruptions to their medical care: postponed screenings and surgeries, missed or delayed diagnoses, fewer overall appointments with doctors, a widespread shift to virtual visits and higher rates of anxiety.
Cancer survivors and patients undergoing treatment had to contend with greater risks of complications and death if they contracted the virus, and problems were more pronounced for patients of color, according to a presentations by oncology specialists and researchers as the symposium kicked off Tuesday.
“Just by having cancer or a history of cancer, a patient is at significantly higher risk from dying if they are infected with the virus,” said Dr. Deborah Doroshow, an assistant professor of medicine with the Tisch Cancer Institute in New York.
SABCS, which draws upward of 8,000 researchers, cancer specialists, patient advocates and sponsors to the Convention Center in downtown San Antonio each December, is typically one of the city’s largest annual conferences. It is being held virtually for the first time this year because of the risks posed by the pandemic, with sessions running Tuesday through Saturday.
Doroshow said one examination of more than 3,800 patients found that those with active cancer or a history of the disease had
a mortality rate of 15 percent at the 30-day mark after they were diagnosed with COVID.
Cancer-related care took a hit during the pandemic, too. A study of a group of more than 2,000 active and former cancer patients seen at Mount Sinai and at the Dana Farber Cancer Institute in Boston found that 40 percent saw decreased number of overall visits after COVID hit, and 52 percent experienced fewer inperson visits and almost a third had increased telehealth visits.
Dr. Annie Tang, a physician affiliated with Kaiser Permanente in northern California, said the state's shelter-in-place orders ushered in drastic changes to the management of breast cancer.
During that period, a study of patients in Tang's health care system determined that there was a 64 percent decrease in the number of patients diagnosed with breast cancer, a drop that translated to about 450 patients.
Additionally, by the time patients were diagnosed, they had more advanced tumors, including a higher prevalence of metastatic disease.
The risks associated with COVID and disruptions to cancer care are compounded for patients of color, Doroshow said. Black and Hispanic patients were more likely to be diagnosed with COVID, but they were less likely to have increased telehealth cancer visits compared to white counterparts. Also, Hispanic patients were more likely than whites to have delays in their care from the pandemic.
“I believe the root cause of these disparities is decades, and certainly centuries, of institutionalized racism,” Doroshow said.
She told the story of a former cancer patient she met on rounds in the COVID ward at Mount Sinai in April. The patient, a Black woman in her 60s, had been receiving oxygen through nasal tubes but was still experiencing shortness of breath and low blood oxygen levels. Doroshow suggested the patient receive greater oxygen support from a high-flow nasal cannula, which would aerosolize the virus, requiring her to be moved to a private room.
The suggestion was met with resistance by other hospital staff, Doroshow said, who said the woman didn't look “that bad.” The woman didn't have active cancer and care wasn't being rationed at the hospital, Doroshow said, causing her to wonder whether the woman was being treated differently because of her gender and race.
The pandemic also has taken an emotional toll on cancer patients, said Dr. Lidia Schapira, a medical oncologist at Stanford University School of Medicine, who have experienced heightened stress, depression and anxiety. In one patient survey, 58 percent of respondents reported higher levels of depression and 61 percent said they were experiencing new or increased mood swings, said Dr. Brittney Zimmerman with Tisch.
Schapira said patients have worried the risks of becoming infected with the virus, especially because some cancer treatments can suppress the immune system. The overnight adoption of telemedicine and shuffling of appointments and mammograms created further psychological burden for patients.
“Cancer survivors got lost in the transition of care delivery,” she said.
Helen Black, a metastatic breast cancer survivor from Washington state, did everything she could to avoid contracting the coronavirus, pulling her children out of school and working remotely. She was terrified after learning in July that she had been infected by her husband, who had caught the virus from coworkers.
For three weeks, Black suffered from severe body aches, headaches, mental fog and physical fatigue. As pain coursed throughout her body, she worried about her lungs, to which her cancer had spread three years earlier. She fielded multiple calls a day from her oncologist, who seemed nervous.
Eventually, Black turned a corner. She began to recover but still dealt with months of headaches and fatigue.
Black said she was grateful that she discontinued one of her breast cancer medications in May, before she fell ill. It's common for the drug, Ibrance, to result in low white blood cell counts, raising patients' risk for severe infections.
“It proved to be the right decision,” Black said. “I'm here today, and back to trying my best to stay isolated and keep my family isolated.”
Still, she is worried about what her next scan may show. The results are due back Saturday.
“By having cancer … a patient is at significantly higher risk from dying if they are infected with the virus.”
Dr. Deborah Doroshow, assistant professor of medicine