Most of the things we worry about rarely come to pass as we imagine. However, when the Director of the National Cancer Institute, Norman E. “Ned” Sharpless, says he’s worried about the impact of the COVID-19 pandemic on cancer patients, there are good grounds for his fears.
Dr. Sharpless contributed an editorial, “COVID-19 and Cancer” to Science, the peer-reviewed academic journal of the American Association for the Advancement of Science. Science is not only respected by scientists and researchers; it also has a wide following in the general public. That’s because in addition to original research, its opinions on science policy and science-related news are interestingly written.
By the time of the editorial’s June, 2020 publication, the nation had already experienced lockdowns in numerous states, and the economy was wounded. The internet and media were flooded with conflicting statistics and information, so it was hard to know what to trust. Emotions ran the gamut from fear, anxiety and suspicion to anger and rebellion. Aside from contracting the coronavirus itself, I believe all of us were affected by what was coming across our devices, TVs, radios and news sources.
As head of NCI, Dr. Sharpless focused his piece on the millions of U.S. cancer patients. The COVID-19 pandemic impacts not only their lives in the now, but also has worrisome implications for their future.
Since the earliest days of overwhelmed emergency departments and intensive care units, and the rapid transition from in-office medical visits to telemedicine, countless imaging-based screenings and diagnostic scans went on hold. On June 19, 2020 Radiology Business reported, “Across the country, radiology providers have reported massive drops in imaging volumes as states have shut down nonurgent care to preserve PPE and keep hospitals open for COVID patients.”[i] a drop in tests like mammograms and colonoscopies means there was a steep drop in newly diagnosed cancer cases. “But,” writes Sharpless, “but there is no reason to believe the actual incidence of cancer has dropped. Cancers being missed now will still come to light eventually, but at a later stage (‘upstaging’) and with worse prognoses.” This is not just a fantasy worry. It’s a probable clinical aftermath of the pandemic.
Sharpless also describes COVID’s impact on treating current cancer patients. With COVID patients needing a greater proportion of available beds, and the potential for in-hospital contamination and infecting clinical personnel, many cancer treatments such as ambulatory chemotherapies and radiation, or surgeries to remove tumors, have been canceled or rescheduled. Sharpless refers to this outcome as “suboptimal care.” Given the opportunistic nature of all cancers, including prostate cancer, the disease takes advantage of delayed treatment to grow and progress.
While the act of worrying is a mental projection of fear into an imagined future, another way to peer into the months and years ahead is to use mathematical models based on real numbers. Instead of fretting about might happen, NCI developed such a model to calculate the outcome of a moderate disruption in cancer care that is fully resolved within 6 months (a conservative guess, since the rollercoaster of COVID spikes may continue until the unknown time when a safe and effective vaccine is available and widely implemented).
Two cancers, breast and colon, were chosen to run the numbers:
Modeling the effect of COVID-19 on cancer screening and treatment for breast and colorectal cancer (which together account for about one-sixth of all cancer deaths) over the next decade suggests almost 10,000 excess deaths from breast and colorectal cancer deaths… The number of excess deaths per year would peak in the next year or two.
This does not take into account all other cancers, the nonlethal but burdensome increase in upstaged disease at diagnosis, and variations during regional spikes and local resources. As if this weren’t bad enough, the pandemic has put the brakes on much laboratory research and clinical testing in human trials. We must assume that this, too, will have a longer-term effect on progress in cancer prevention, advances in technology and treatment, and ultimate discovery of cures.
Hope = action
Sharpless does not believe in sitting idly by and fretting. He urges clinical and research communities and government agencies to work together to lessen the likelihood of excess cancer deaths. As an example, he cites cooperation between the NCI and the Food & Drug Administration to generate more flexibility in clinical trials to allow for pandemic-related hindrances to protocol. Also, the NCI has announced new clinical trials and funding opportunities to explore the relationship between COVID-19 and cancer.
Sharpless acknowledges that prudent actions that were taken during the initial surge of the pandemic. But, as he told one interviewer, “Now is the time to reopen cancer care… Hospitals that are now seeing fewer Covid-19 patients are beginning to ramp up care and patients shouldn’t be afraid to go there, if they observe reasonable precautions…”[ii]
Hope lies in action, and Sharpless’ message is clear. We can’t wait too long to address the needs of cancer patients, lest we “turn one public health crisis into many others.”
NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.
[i] Stempniak, Marty. “Model predicts 10,000 excess US deaths due to cancer screening delays: ‘We’re very worried’.” Radiology Business, Jun 19, 2020.
[ii] Cooney, Elizabeth. “Ignoring cancer care now may trade one public health crisis – Covid-19 – for another, NCI chief warns. STAT, Jun 19, 2020.