Five-Year Impact of the COVID-19 Pandemic on the Oncology Community

In March 2020, the COVID-19 pandemic altered day-to-day life in the US and the world. Specifically, patients who had cancer and were receiving treatment were one of the most vulnerable populations because of their weakened immune systems. Overnight, the health care industry had to adapt to new protocols and find ways to safely treat these patients without exposing them to additional life-threatening circumstances.

Now, 5 years after the pandemic began, CancerNetwork and clinicians in the multidisciplinary space are taking a look back to see what changes were implemented and whether they impacted the oncology field for better or for worse. During this time, institutions across the country, societies, and nonprofit organizations have created resources regarding the COVID-19
pandemic and how to best move forward.

Influence of COVID-19 Studies

Studies have been conducted during the past 5 years regarding the impact the pandemic had on cancer care. Most importantly, they looked at populations and access to care.

The American Cancer Society (ACS) has created a comprehensive guide regarding questions patients or clinicians may have about COVID-19 and cancer care.¹ The Memorial Sloan Kettering (MSK) Cancer Center library discusses the use of COVID-19 treatment for patients with cancer as well.² They noted that patients with cancer have a higher rate of progressing with COVID-19 and, therefore, should receive anti–SARS-CoV-2 therapies in the outpatient setting.

MSK also highlighted that for patients who need supplemental oxygen or mechanical ventilation, the use of dexamethasone has been shown to lower mortality. For patients with severe or critical COVID-19 who have respiratory decompression, dexamethasone plus tocilizumab (Actemra) and baricitinib (Olumiant) are recommended.

One of the resources on the ACS platform directs clinicians to the COVID-19 and Cancer Consortium (CCC19), which is currently evaluating 126 institutions and looking into the effects of the pandemic on the institutions as a whole, specific patient populations, and by disease type.³

One such study looked at racial disparities in COVID-19 outcomes among patients who are Black or White with cancer.⁴ The study found that of the 3506 patients, patients who were Black had worse illness and worse COVID-19 severity than those who were White (unweighted OR, 1.34; 95% CI, 1.15-1.58; weighted OR, 1.21; 95% CI, 1.11-1.33).

“What came out of the pandemic was this recognition of the importance of these upstream structural and social drivers of health, as we recognize that there were populations right here in our country that were more impacted than others in terms of being infected, as well as outcomes following infection. The pandemic has helped to pave recognition of the importance of upstream factors,” Scarlett Lin Gomez, PhD, MPH, professor in the Department of Epidemiology and Biostatistics and coleader of the Cancer Control Program at the University of California San Francisco Helen Diller Family Comprehensive Cancer Center, said during an interview with CancerNetwork.

Change in Cancer Screenings

The Joint Research Centre, which is part of the European Commission, conducted a survey and published the results in February 2023.⁵ Researchers looked at European cancer registries between March and May 2020 to better understand how the first wave of the pandemic impacted cancer screenings.

Overall, about 90% of patients reported an interruption or slowdown of population-based screening for breast, cervical, and colorectal cancers. Additionally, surgery was disrupted in 51% of respondents, chemotherapy in 43%, immunotherapy in 44%, and radiotherapy in 40%.

“[COVID-19] did affect the care of screening. Many patients fell off as far as getting their colonoscopies, which probably meant an increased incidence of more advanced disease because, for a few years, some patients didn’t get their mammography or colonoscopy, etc. Now we’re playing catch-up in that situation,” Marwan G. Fakih, MD, professor in the Department of Medical Oncology and Therapeutics Research, associate director for Clinical Sciences, medical director of the Briskin Center for Clinical Research, division chief of Gastrointestinal Medical Oncology, and codirector of the Gastrointestinal Cancer Program at City of Hope, said during an interview.

Implementation of Telehealth

A major consensus across all clinicians was the use of telehealth and its positive impact on the health care space. A systematic review published in 2024 assessed the effectiveness of telehealth compared with in-person care during the pandemic. Differences in health care utilization were noted as small and/or not clinically meaningful.⁶ For process outcomes, there were lower rates of missed visits and changes in therapy or medication, with higher rates of adherence for those who had initial telehealth visits. The rates of laboratory results or paraclinical assessment were found to be lower among those with initial telehealth visits.

In 2024, the House Ways and Means Committee passed the Preserving Telehealth, Hospital and Ambulance Access Act.⁷ This was to further expand the regulatory flexibility to telehealth put in place during the COVID-19 pandemic, but coverage was set to expire in 2024. At the beginning of the pandemic, the Centers for Medicare & Medicaid Services had enabled widespread use of telehealth, such as virtual visits across state lines, audio-only care, and waiving in-person requirements for prescriptions.⁷ In December 2024, an extension was made through March 31, 2025, which allowed Medicare and hospital-at-home services, like telehealth, to continue to be covered.⁸

“The role of telehealth and for patients to do visits remotely has been a good thing. We’ve been able to provide patients care, be able to connect with them, and get the information that we need. The only limitation is the inability to do the physical examination and vitals. [Telehealth] has enhanced care,” Ritu Salani, MD, MBA, director of gynecologic oncology at UCLA Health and editorial advisory board member for ONCOLOGY, said during an interview.

Forward Thinking

Over the past 5 years, countless research articles have come out not just in the cancer space but in health care in general regarding the pandemic. The public health emergency was ended in May 2023, but questions remain about the impact of COVID-19 and cancer care.⁹

The European Commission highlighted key points on what to expect after the pandemic, including a lower reported number of cancer incident cases from 2020, higher stage at diagnosis, and a negative impact on survival.

Organizations like CCC19 are still looking at and compiling data regarding the pandemic. Long-term follow-up is occurring, and it will be important to look at these results and analyze how future pandemics may impact patients with cancer.

“The COVID-19 pandemic showed how resilient not only patients can be but medicine as a field, that if we’re up against something, we find ways to adapt or try to make things better, to adjust to the pandemic,” Frances Elaine Chow, MD, a neuro-oncologist at USC Norris Comprehensive Cancer Center, concluded. “Hopefully, we won’t run into other pandemics or world-changing conditions, but we will continue to evolve and develop as a field to make things easier for our patients.”

References

1. Questions about COVID-19 and cancer. American Cancer Society. March 25, 2024. Accessed February 5, 2025. https://shorturl.at/RwwNP
2. COVID-19. Memorial Sloan Kettering Library. Updated February 5, 2025. Accessed February 5, 2025. https://shorturl.at/SiHL4
3. The COVID-19 and Cancer Consortium. Accessed February 5, 2025. https://shorturl.at/xlOnV
4. Fu J, Reid SA, French B, et al. Racial disparities in COVID-19 outcomes among Black and White patients with cancer. JAMA Netw Open. 2022;5(3):e224304. doi:10.1001/jamanetworkopen.2022.4304
5. Cancer care in times of COVID-19: lessons for future pandemics. EU Science Hub. February 28, 2023. Accessed February 5, 2025. https://shorturl.at/79Wsj
6. Hatef E, Wilson RF, Zhang A, et al. Effectiveness of telehealth versus in-person care during the COVID-19 pandemic: a systematic review. NPJ Digit Med. 2024;7(1):157. doi:10.1038/s41746-024-01152-2
7. Henry TA. Bill to extend telehealth flexibilities clears House committee. American Medical Association. August 15, 2024. Accessed February 5, 2025. https://shorturl.at/oczue
8. Seegert L. Congress extends more telehealth care just before the 2024 holidays. Penn Leonard Davis Institute of Health Economics. January 14, 2025. Accessed February 5, 2025. https://shorturl.at/wS2k9
9. WHO chief declares end to COVID-19 as a global health emergency. UN News. May 5, 2023. Accessed February 5, 2025. https://shorturl.at/TeSOt