Dr. Len Lichtenfeld

COVID-19— which stands for coronavirus disease 2019 and is caused by a virus named SARS- CoV2 &mdash; is a serious illness for anyone, and especial- ly so for patients with cancer. Cancer treatments, particularly those that specifically weaken the immune system, leave patients with cancer more susceptible to the ravaging effects of the corona- virus and can lead to death in a larger proportion of these patients who become infected compared with the general population.

That’s one reason that measures to protect these patients from the virus are going beyond the hand- washing and social distancing recommended for everyone and actually affecting treatments for the cancer itself.

Cancer care will be disrupted during this pandemic. In some parts of our country, cities will be severely affected, and the resources of health care teams and their supporting services such as labs, radiology departments and operating rooms will be diverted elsewhere to serve the needs of those in immediately life-threatening circumstances.

At the American Cancer Society call center, about 80% of the calls are now related to coronavirus questions. Patients are seeing their treatments disrupted with delays or are having surgeries and radiation therapy sessions canceled. Some are questioning the safety of their oncologists’ offices, where patients and caregivers sit close together or may have to share a single bathroom. Cancer survivors are asking whether, as health care workers themselves, they can even go to work.

Cancer centers are literally reacting to the changes demanded by coronavirus on a day-to-day basis. This is truly uncharted territory, with no road map on how best to respond.

For some patients, such as those with a small, non-invasive and non-aggressive ductal carcinoma in situ breast cancer, surgery may be delayed while anti-hormonal treatment is started earlier. For others, such as patients with acute leukemia or advanced lymphoma, where time is of the essence, there is little doubt that their care will be prioritized.

Many centers are moving patients to virtual visits when the situation allows. Reconstructive surgery after breast cancer may be delayed, since operating suites are being closed and ventilators moved to acute care. And, unfortunately, we are hearing the difficult stories from patients whose treatment may not be considered lifesaving and therefore has been canceled for the immediate future.

Difficult decisions are going to be made, especially in communities where the virus is rampant. These aren’t easy choices; however, they are necessary choices, since in some cases there are no other options. No health professional ever thought they would have to have these conversations; no patient or caregiver ever thought they would have to hear them.

We don’t know today what the total impact of the COVID-19 pandemic will be on cancer care, clinical trials and outcomes. It will take years of study to figure out whether we were able to meet the challenge or suffered negative outcomes that would not have been dreamed of even a few short weeks ago.

As trite as it may sound, we are indeed all in this together — every one of us. If we stay focused and committed, we will get through this and continue back to our lives with some degree of routine and normalcy. That is our prayer and that is our hope.

Articles

With the COVID-19 Pandemic making a major impact on the cancer landscape, Dr. Len Lichtenfeld discusses how the coronavirus is impacting the patient's cancer treatment and what can be done to navigate it. 

House Call: COVID-19 Concerns Are Interrupting Cancer Treatment

Recently, The American Cancer Society released its annual report on cancer statistics in the United States, which tells us quite a bit about cancer diagnoses and outcomes. The findings are widely quoted in the media and elsewhere and for good reason: They provide a wealth of information that can guide us on how to better detect and treat cancer in this country.

This year’s report had very positive information: The rate of cancer deaths declined 27% in 25 years. However, it also offered some observations that should be deeply concerning to all of us: When it comes to cancers that can be effectively detected early, such as lung, cervical and colorectal, the outcomes for individuals in rural communities around the country are much worse than for those who live in more urban settings. In contrast, for cancers for which there are no early detection tests, such as leukemia, we don’t see these differences.

The reasons are likely many, including factors that we know make a difference: education, social and economic status and access to care. These are the same issues that affect the availability of cancer care and make it more difficult to get the best treatment if you live in a location where expert facilities are not available or are many miles away.

There are no simple answers to this dilemma. Unfortunately, in some states, such as Georgia, rural hospitals are no longer financially sustainable, and their doors are closing. In many counties, basic health care from primary care clinicians isn’t available, let alone specialty care such as oncology. With the complexity of cancer care only increasing, it is unlikely that the situation will get better soon.

For me, the findings about the differences in outcomes for detectable cancers in rural communities was a bit of an eye-opener. It is one more symptom of a complex problem that we need to face. The concern is not just cancer care and treatment in our rural areas, but also survival rates for cancers we have the tools to diagnose early, when treatment is more effective and can make a real difference for many folks.

If we can’t meet that basic expectation — to detect and treat cancer early in its course, when we know it makes a difference &mdash; then how are we going to continue making the progress against cancer that we are clearly capable of making?

We need to find and employ innovative solutions to solve the disparities in outcomes for those who live in rural communities. We must provide access to appropriate cancer screening through innovative programs such as mobile screening, access to HPV vaccination and improvements in telemedicine. We should provide education and outreach about cancers and their detection, aimed at all ages, from children to the elderly. Finally, we need to help our communities, legislators and the leaders of state health programs understand that these differences in outcomes are very real — and deserving of their attention.

Dr. Len Lichtenfeld is acting chief medical officer of the American Cancer Society.

The rate of cancer deaths has declined 27% in 25 years, but when it comes to cancers that can be effectively detected early, such as lung, cervical and colorectal, the outcomes for individuals in rural communities around the country are much worse than for those who live in more urban settings.

Dr. Len Lichtenfeld

House Call: COVID-19 Concerns Are Interrupting Cancer Treatment

National Drop in Cancer Deaths Is Encouraging, but Inconsistent, as Improvements in Rural Areas Lag

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