Five Years After the COVID-19 Pandemic: Effects on Cancer Care

Julie M. Vose, MD, MBA, discusses some of the lasting effects that the COVID-19 pandemic has had on the current state of cancer care.

In 2020, a cluster of patients in Wuhan, China, fell sick with a viral disease that had never before been reported. At first, the virus did not have a name, but eventually, it was called SARS-CoV-2, and the disease was named COVID-19. We will likely never know how the virus originated. However, 5 years later, the viral pandemic’s effect is still felt throughout hematology/oncology clinical care and research. Because the virus affects older or immunocompromised patients at an increased rate, patients with cancer are disproportionally affected.

In addition, early in the pandemic, there was a decrease in the number of new cancer cases diagnosed. Fewer standardized screening tests were being performed, and fewer referrals were made for cancer care. This delay in screening led to cancers being diagnosed later in the course of the disease and, therefore, more difficult to treat. Results of one study showed a decrease of 98,000 curative intent surgical procedures performed, 38,000 fewer chemotherapy regimens, 55,500 fewer radiotherapy regimens, 6800 fewer immunotherapy regimens, and 32,000 fewer hormonal therapies initiated in 2020.¹ The number of new cancer cases being diagnosed has come back to prepandemic levels. Early in the pandemic, enrollments in cancer clinical trials dramatically decreased, and the increased death rates in immunocompromised patients from COVID-19 itself confounded the trials’ results.

What have we learned from the pandemic?We have learned that highly contagious pathogens can significantly affect cancer screening, diagnosis, treatment, and follow-up. Without the proper infrastructure, these problems could easily repeat themselves. Public health principles and infectious disease research are essential to avoid or manage the next emergency. A few good things came out of the pandemic, including the advances in the use of telehealth video for patient care and the modernization of the process for remote laboratory testing, data, and use of local health care resources. In addition, transparency in the clinical trial process and allowing local health care testing and care will greatly enhance the ability of patients to participate in clinical trials from rural locations. Real-world evidence and pragmatic clinical trials will also be more critical forms of knowledge in the future,informing treatments for our patients with malignancies. We can only hope other viral mutations will not lead to such disruption of cancer care in the future.

Reference

Nogueira L, Schafer E, Fan Q, et al. Assessment of changes in cancer treatment during the first year of COVID-19 pandemic in the US. JAMA Oncol. 2024;10(1):109-114. doi:10.1001/jamaoncol.2023.4513