One in four cancer patients in US faces delay in treatment as coronavirus cripples hospitals: Study
Nearly one in four cancer patients in the US is reporting a delay in care or treatment. The most common delays are for in-person provider appointments (50%), delayed access to imaging services to determine if a patient’s cancer had grown or returned (20%), access to supportive services including physical therapy or mental healthcare (20%), and access to anti-cancer therapy such as chemotherapy and immunotherapy (8%). These are the findings of a survey by the American Cancer Society Cancer Action Network (ACS CAN).
Among patients and survivors currently in active treatment, the incident of changes, delays or disruptions increases to 55%. According to the study, among the respondents who are in active treatment, 27% report a delay in their care. More than 1 in 8 (13%) of those in active treatment have had care delayed without knowledge of when it will be rescheduled, indicating a great deal of uncertainty about their future ability to access care.
"Fifty percent of cancer patients and survivors reported some impact on their healthcare due to the COVID-19 pandemic. A third of cancer patients and survivors are worried about the impact of COVID-19 on their ability to get treatment for their cancer, a concern that is particularly acute for those currently in active treatment (40% of whom express worry)," the findings state.
According to experts, these patients are the hidden victims of the COVID-19 pandemic. "Cancer care, which often involves immunosuppressive therapy, tumor resection, and inpatient treatment, has been disproportionately affected by COVID-19," says a report in the New England Journal of Medicine (NEJM). "For example, though patients with low-grade lymphoma typically receive maintenance therapy, it will not be recommended for now because it requires an office visit, worsens immunosuppression and improves progression-free but not overall survival. Other protocol modifications have arisen because of cancellations of elective surgeries. For instance, some patients with solid tumors, such as breast and rectal cancers, are being offered systemic therapy before, rather than after, surgery," says the report.
The COVID-19 pandemic and responses to help prevent its spread have had far-reaching impact on all Americans, and particularly on cancer patients and survivors. Risk of infection, overloaded healthcare systems, shortages of food and supplies and economic challenges all create unique barriers to achieving and maintaining health while fighting cancer, say experts. Accordingly, to better understand the impact of COVID-19 on the vulnerable population of US cancer patients and survivors, the ACS CAN initiated a survey on March 25, which was deployed across two weeks to 3,055 cancer patients and survivors. The web-based survey was taken by more than 1,200 cancer patients and survivors.
The survey included a wide range of US cancer patients and survivors who have been diagnosed with and/or treated for cancer within the last five years. Fifty-one percent of respondents are currently being treated for cancer. Among respondents who are not currently in active treatment, more than half (60%) received their last treatment within a year.
In addition to delays and cancellations, many cancer patients and survivors reported the transition of healthcare services from in-person to remote delivery. The analysis shows that 15% of respondents have had an in-person provider visit changed to a phone or video visit.
"The health effects of this pandemic stretch well beyond those diagnosed and suffering from COVID-19 and are having an acute and adverse impact on cancer patients, many of whom can’t afford treatment delays. Cancer patients are dealing with understandable, but in many cases, unsustainable delays in their care. This data shows the need for quick action in bolstering our health care system so we can both care for those diagnosed with the virus and for those facing a cancer diagnosis," says Lisa Lacasse, president of the American Cancer Society Cancer Action Network, in the analysis.
The American Society of Breast Surgeons (ASBrS) recently issued recommendations for prioritization, treatment and triage of breast cancer patients during the pandemic, which call for priority levels (A, B, C) for the urgency of care across all specialties. Priority categories were defined based on the severity of an individual patient’s condition (including patient comorbidities) and potential efficacy of treatments.
“Priority A patients have conditions that are immediately life-threatening or symptomatic requiring urgent treatment. Priority B patients have conditions that do not require immediate treatment but should start treatment before the pandemic is over. Priority C patients have conditions that can be safely deferred until the pandemic is over. The implementation of these recommendations for patient triage, which are based on the highest level available evidence, must be adapted to the current availability of hospital resources and severity of the COVID-19 pandemic in each region of the country,” say the guidelines.
The experts say that additionally, the risk of disease progression and worse outcomes for patients need to be weighed against the risk of patient and staff exposure to the COVID-19 virus.
Economic impact
Like many across the US, cancer patients are also feeling economic stress in the wake of the pandemic. Nearly 4 in 10 (38%) respondents say COVID-19 is having a notable effect on their ability to afford their care, mostly due to reduced work hours.
“The most common financial issues affecting access to care for cancer patients and survivors include reduced work hours (14%), reduced investment values (11%), difficulty affording food and supplies to stay at home to avoid contracting the virus (9%) and loss of a job (8%),” says the study.
Reduced work hours and lost jobs are of particular concern with regard to paying for healthcare because these have the potential to impact access to health insurance. According to the analysis, 43% of respondents who reported that they or a family member living with them had lost a job, had employer-sponsored health insurance. Among those who indicated they or a family member had work hours reduced, 58% had employer-sponsored coverage.
Nearly half of cancer patients and survivors whose annual household income is $30,000 or less are worried that the financial impact of the COVID-19 pandemic will make it hard for them to afford the care they need, say experts. "28% of all respondents expressed worry about the financial impact of COVID-19 making it difficult to pay for the health care they need as cancer survivors. This concern was highly correlated with income, with 46% of those earning $30,000 or less reporting they are worried. Even in households earning more than $110,0002, one in five (21%) respondents expressed concern about the financial impact," says the study.
Patient groups are asking Congress and the Trump administration to take action on policy changes that would help them. "Those changes include creating a special enrollment period so that uninsured or underinsured Americans can enroll in comprehensive health plans established under the Affordable Care Act (ACA), and increased funding for state Medicaid programs. It also includes subsidies to help people who lose their employer-sponsored health care afford their health insurance premiums for up to six months," say experts.