When a global pandemic complicates cancer care

S ince the first cases of Coronavirus Disease 2019 (COVID-19) were reported in China in early January and the disease subsequently spread to the United States and nearly 200 countries, the oncology community has had to adapt to an ever-evolving medical emergency while trying to ensure the health and safety of patients with cancer. However, faced with limited data on how the virus specifically affects people with cancer and other unknowns that surround a new disease, clinicians say that they have struggled at times to make decisions about care and have found themselves second-guessing treatment strategies. “Our initial reaction was to avoid patient and health care worker exposure to infection, and we canceled as many visits and procedures as possible,” says Antoni Ribas, MD, PhD, president-elect of the American Association for Cancer Research (AACR) and director of the Tumor Immunology Program at the Jonsson Comprehensive Cancer Center at the University of California Los Angeles. Of course, withholding active therapies and giving cancer a chance to progress also pose a risk, so Dr. Ribas tried to strike a balance. He continued to treat patients who recently had started immunotherapy while advising others on maintenance therapy to stop treatment temporarily. “But I don’t know if it was the right thing to do,” he says. Patients have also raised concerns about treatment in a world reshaped by the coronavirus. At the 24-hour support line of the American Cancer Society (ACS), 80% of calls, as of press time, are related to COVID-19, says ACS Deputy Chief Medical Officer J. Leonard Lichtenfeld, MD, with patients voicing fears about access to and interruptions in care. Researchers and cancer organizations have responded by carefully examining early data from some of the most heavily affected regions and identifying key questions that require further study. They are also working to create a clearer picture of how the virus is affecting day-to-day cancer care and the areas in which patients may need additional support. For example, to better understand how people with cancer are faring in the pandemic, the ACS Cancer Action Network conducted a nationwide survey of more than 1200 patients between March 25 and April 8. Consistent with questions that the ACS has fielded through its hotline, this survey found that: • Approximately 27% of patients currently in active treatment have reported a delay in treatment. • Approximately 13% have had their treatment delayed without knowledge of when it would be rescheduled. • One-third of all patients say that they are worried about the impact the virus will have on their ability to get care; this is especially true for those in active treatment (40%). • Nearly 4 in 10 (38%) have said that COVID-19 is affecting their ability to afford care, mostly because of reduced work hours. “We’ve pivoted in no small way to address some of the questions raised by COVID-19 and have partnered with various cancer registries to study its impact on cancer patient care,” Dr. Lichtenfeld says. He notes that the ACS is also developing recommendations for how physicians can safely resume cancer screenings. Major cancer conferences have shifted their focus to the coronavirus as well even as organizers have moved proceedings online to prevent its spread. The AACR’s annual meeting, for example, was originally scheduled for April 24 to 29 in San Diego, California, but was rescheduled as 2 virtual meetings held on April 27 to 28 and June 22 to 24, with a third, 3-day meeting in July dedicated to COVID-19 and cancer. At the AACR’s April meeting, Dr. Ribas chaired a plenary session in which clinicians and researchers from China, Italy, Although oncologists and their patients are accustomed to fighting tough battles against a lethal disease, Coronavirus Disease 2019 (COVID-19) has posed an unprecedented challenge When a Global Pandemic Complicates Cancer Care