April 1 (UPI) — Some Americans with cancer are experiencing disruptions to treatment because of the COVID-19 pandemic, experts acknowledged Wednesday.
With hospitals in many parts of the country overwhelmed with patients with the new coronavirus, or bracing for an overflow of contagious COVID-19 patients, many clinicians have advised those with cancer to forego chemotherapy and radiation treatment until the outbreak has run its course.
The reason, healthcare providers say, is to avoid exposing patients with already compromised immune systems, such as cancer patients, to the coronavirus. According to a study published Wednesday, pausing treatment also was used as method of protecting patients in China, where the pandemic started, to protect patients.
The American Cancer Society has received hundreds of calls from people with cancer who have experienced treatment interruptions since the pandemic reached the United States, Dr. Len Lichtenfeld, deputy chief medical officer at the organization, told UPI.
The decisions regarding discontinuing treatment, he emphasized, are being made based on existing evidence that weighs benefits against potential risks.
“We knew this outbreak was going to be of high risk not just to cancer patients in active treatment, but in those in post-treatment, as well,” Lichtenfeld said.
“The resources healthcare centers do have need to be focused on people who are being treated for cure and people who have an acute need for treatment, like people with acute lymphoma. Those diseases don’t wait.”
What this might mean, for example, is that patients who otherwise would have received a third, fourth or fifth round of chemotherapy — as part of an “aggressive” treatment plan, despite the limited benefits these additional courses provide — are having those requests denied.
A review published Wednesday in JAMA Oncology notes that “maintenance chemotherapy and/or immunotherapy treatments for patients with advanced cancer” often were suspended in many parts of China during the COVID-19 outbreak there.
For those who continued cancer treatment during the outbreak, several safeguards were put in place, including temperature checks upon arrival for appointments and routine monitoring for COVID-19 among patients admitted to the hospital for cancer care, the authors said.
Although no precise data exists about the risks for cancer patients from COVID-19, it is well known they are more prone to infections, both because of the disease and its treatment, according to the American Cancer Society.
A study out of Wuhan, China, published last month in The Lancet found that 18 of 1,590 patients, or 1 percent, with severe COVID-19 had a history of cancer.
The national incidence of cancer in the Chinese population is 0.29 percent, according to the authors.
Since early March, the U.S. Centers for Disease Control and Prevention has recommended that healthcare facilities and doctors prioritize urgent and emergency visits and procedures.
The agency has not offered specific guidance about cancer care, but it’s believed that many hospitals are evaluating patients on a case-by-case basis and postponing treatment when doing so does not pose a risk to health.
These decisions aren’t made with only the patients in mind, either, experts have said. Clinicians involved in delivering cancer treatment — oncologists, radiologists, nurses and others — also are at risk for COVID-19, often simply by reporting for work at a facility at which patients with the infection have been admitted.
As the authors of the Lancet paper noted, the measures put in place to protect patients from the new coronavirus also were designed avoid COVID-19 “cross infection between patients and medical staff.”
In addition to delaying cancer treatment, ACS also recommends that people should not have routine screening for breast, colon, cervix or lung cancer until social distancing measures put in place to stem the pandemic have been lifted.
Although screening often results in earlier diagnosis and saves lives in people with cancer, continuing services at normal levels could overburden medical facilities still coming to grips with the thousands of patients testing positive for the new coronavirus.
“There are going to be indirect effects of this pandemic, and those effects are not just related to postponing treatments or elective surgeries, but also the shift in priority among many hospitals and healthcare centers to treat exclusively COVID-19,” Dr. Caroline Buckee, associate professor of epidemiology at Harvard T.H. Chan School of Public Health, said in a call with reporters Wednesday.
“And so, when we think through the impact of the pandemic, we need to not only think about deaths attributable to COVID-19, but also any other mortality that might arise as a result of re-directed medical care or redirected financial or healthcare resources,” Buckee said. “It’s a very important issue.”