COVID-19 pandemic will bring additional cancer deaths

By Dr. Ananya Mandal, MDApr 30 2020

The COVID-19 pandemic is far from over, the World Health Organization says. At a press conference in Geneva, Switzerland Monday, Director-General, Dr. Tedros Ghebreyesus, had this to say.

"We continue to urge countries to find, isolate, test, and treat all cases and trace every contact to ensure these declining trends continue. But the pandemic is far from over.WHO continues to be concerned about the increasing trends in Africa, Eastern Europe, Latin America, and some Asian countries", he said.

With over 3.25 million people infected, healthcare systems of even the most developed nations are overwhelmed. Cancer patients and survivors, for example, are particularly vulnerable during this epidemic and not only because of their increased vulnerable immunocompromised state, which makes them prone to the infection. They are also at risk of missing out on essential cancer care due to the unavailability of resources.

The coronavirus (blue) is simple biologically, but complicated in how it infects a host. CDC/ Hannah A Bullock; Azaibi Tamin

18,000 cancer patients

A new study has shown that an extra 18,000 cancer patients in England would lose their lives during the COVID-19 pandemic mainly because hospitals caring for these patients have had to suspend and postpone the treatment due to them from the NHS care. According to UK chief medical adviser Prof Chris Witty, this is one of the "indirect" costs of the coronavirus pandemic.

Delays

This new study from the University College London (UCL), in collaboration with Data-Can was one of the first to look at the impact of the delay in cancer care provided by the NHS during this pandemic situation. Data-Can is a health data research lab that records cancer diagnosis and treatment data from patients across the United Kingdom.

This study looks at the potential impact of delaying diagnostic tests, screening tests, surgeries, and chemo and radiation therapy by the NHS. Also taken into account were patient's fears of becoming infected as a result of visiting health facilities. This database covers over 3.5 million patients in England, and from that, results have been derived.

What was found?

The researchers noted that there would be an additional 17,915 deaths due to cancer and indirectly due to the pandemic during this time. Some of the deaths could be due to delayed diagnosis or delayed treatment for cancer.

They noted that 6,270 people in England, newly diagnosed with cancer, are set to lose their lives over the next 12 months due to the suspension, postponement, and disruption of their treatment schedules. The additional 17,915 deaths is an increase of 20 percent over the 89,576 deaths seen annually due to cancer in England say the reports.

The study also shows that there have been 21,678 deaths due to coronavirus infection, and over 4,300 persons have died in care homes over the past fortnight. The NHS has called for resuming the care provided to seriously ill patients and cancer patients. Still, over the last couple of months since February, cancer test referrals from general practitioners have fallen by 76 percent, and there has been a drop of 60 percent in the appointments for chemotherapy sessions. The NHS has, however, repeatedly urged cancer treatment to "continue unaffected."

Conclusions and impact

The researchers conclude, "Our data have highlighted how cancer patients with multimorbidity are a particularly at-risk group during the current pandemic. In order to ensure effective cancer policy and avoid excess deaths, both during and after the COVID-19 emergency, it is critical to ensure near-real-time reporting of cause-specific excess mortality, urgent cancer referrals, and treatment statistics, so as to inform the most optimal delivery of care in this extremely vulnerable group of patients."

This  study shows that there are widespread impacts of this pandemic that are not just linked to the coronavirus infection alone. The Macmillan Cancer Support calls this the "forgotten C" of the corona pandemic crisis and has expressed concern over the findings of this study. This study concludes that 80 percent of the extra deaths at this time would be due to newly detected cancers among those who already have other ailments such as high blood pressure, heart disease, diabetes, or obesity.

Dr. Alvina Lal, lead author of the study, a lecturer in health data analytics at UCL's institute of health informatics, in her statement said, "Our findings demonstrate the serious potential for unintended consequences of the response to the Covid-19 pandemic, which may negatively impact on patients with cancer and other underlying health conditions." She added that the NHS needs to identify the patients who are affected by cancer and are vulnerable at this critical time. Their care should be prioritized so that risk to their health is reduced, she said.

Prof. Mark Lawler, the lead author from Queen's University Belfast and Data-Can, said, "The results are concerning. We believe countries need to understand how the emergency is affecting cancer outcomes rapidly, otherwise, we risk adding cancer and other underlying health conditions to the escalating death toll of the Covid-19 pandemic."

Experts

NHS England is spreading awareness among the general population to report and ask for help in case of any worrying symptoms or serious ill-health. They have asked people to dial 999 or visit the A&E or the GP without delay. The NHS hopes that cancer-related surgeries would soon be resumed and hopes to cover the backlog suffered over the past couple of months due to patients putting off the hospital visits and surgeries.

Prof. Peter Johnson, an oncologist from NHS England, also said there are serious implications of delayed diagnosis and treatment of cancer. He urged people to get a suspicious lump or mole checked as soon as possible. He said there are "COVID free cancer hubs" in 19 regions of England, and these services can be availed for diagnosis and treatment of cancers.

Prof. Harry Hemingway, senior author of the paper and director of UCL's institute of health informatics, in his statement, said, "The overall impact of the Covid-19 emergency on deaths in cancer patients could be substantial. There are many factors operating here, including rapid changes to diagnosis and treatment protocols, social distancing measures, changes in people's behavior in seeking medical attention, and [the] economic impact of Covid-19, as well as deaths due to Covid-19 infection."

Lynda Thomas, Macmillan's chief executive, added, "This research shows the possible extent of the direct and collateral damage caused by coronavirus on the health of our nation and to the lives of people living with conditions like cancer. It's extremely worrying that we are likely to see an increase in deaths of people newly diagnosed with cancer. We are calling on all governments to stop cancer becoming the forgotten C and urgently ensure cancer services are getting everything they need to recover and catch up as quickly as possible from the disruption of the pandemic. This means having the right staff, protective equipment, and testing to deliver safe care."

NHS England chief executive Simon Stevens has asked the general public to seek health care when needed, and Health Secretary Matt Hancock this week also announced that healthcare services are to be normalized and restored as soon as possible.