Recently a patient of mine came to the clinic with a new cough and shortness of breath. Although I was already treating him for stage 4 colon cancer that had injured his lungs, his acute symptoms made me even more concerned about Covid-19. Tragically, he died the next day when the coronavirus easily overwhelmed an immune system castrated by cancer and chemotherapy.
In addition to cutting down numerous cancer patients, the virus has improved cancer diagnosis, treatment and research.
Almost a year after the pandemic began, many of the fears of oncologists like me have fully materialized in clinical practice. In addition to cutting down numerous cancer patients, the virus has improved cancer diagnosis, treatment and research. Covid-19 naturally attacks the lungs, but it also disrupts other organs – and really the entire health system. Meanwhile, Covid has been linked to heart disease, diabetes, stroke, low blood cell counts and psychiatric illnesses.
Cancer patients have little resistance to Covid-19. The older you get, the higher your risk of cancer. However, advanced age is also a risk factor for the coronavirus. Metabolic disorders associated with cancer, such as obesity, high blood pressure, and diabetes, add to another vulnerability.
A study in the JCO Global Oncology Journal looked at how patients diagnosed with Covid-19 during the early part of the pandemic fared in Asia, Europe and the United States. It found that patients with cancer had worse outcomes (greater need for intensive care and higher mortality) than patients without cancer.
Based on data from the UK, an analysis published in Nature found that Covid-19 infection was particularly fatal within the first year of a cancer diagnosis. Compared to patients without cancer, patients with solid organ cancer (e.g., breast, lungs, and colon) had 1.8 times the risk of death, while patients with blood cancer had a four times higher risk.
And unfortunately, the results of a recent University of Pennsylvania study show that even those whose cancer is in remission and who are currently not in need of therapy remain susceptible to severe Covid-19 infections.
Nathan Berger, a professor and oncologist at the Case Western Reserve School of Medicine, recently told STAT News, “The combination of virus and cancer is synergistic and causes mortality. Mortality rates are much higher than either disease alone. “
But even those cancer patients who had avoided direct infection could not completely escape the seismic effects of the coronavirus on health systems. As health care resources were reallocated to the pandemic response, staples like elective cancer surgery and radiation were postponed while systemic therapies like chemotherapy were delayed.
With cancer, time is extremely precious. A study in the British Medical Journal found that just four weeks of delaying cancer treatment for seven different cancers, including breast, lung and colon, increased mortality.
Routine screenings for breast, cervical and colon cancer also took a nosedive during the pandemic due to insurance issues or fears of getting Covid-19 out of healthcare facilities. In the past year, these screenings were down by more than 90 percent compared to previous years.
The full effect of these absent or delayed colonoscopies and mammograms has not yet been registered.
While the full effects of these absent or delayed colonoscopies and mammograms have not yet been registered, it is possible – probably even that many preventable or early-stage cancers have simply been overlooked. William Cance, the American Cancer Society’s chief medical and scientific officer, grimly told the Wall Street Journal, “We will undoubtedly have delays in diagnosis and more advanced cancers.”
Research studies exploring new avenues and opportunities for cancer treatment have also been undone by bans and dwindling recruits. Given that cancer remains the second leading cause of death in America and is only likely to increase due to increasing life expectancy and exposure to risk factors, the new drugs and therapies that have been discovered in studies are crucial.
Oncologists like me are feeling the weight of Covid-19’s daily interventions in our patients’ cancer care. Any unexplained fever, cough, or vague symptom in a patient will now heighten concerns and add an extra layer of paranoia, risk, and complexity. Unsurprisingly, oncologists reported spikes in their personal anxiety and depression during the pandemic.
While the ongoing introduction of vaccines offers hope, it is fraught with uncertainties. Like so many gray areas around Covid, it is not known whether an immunocompromised cancer patient can develop an adequate immune response to the vaccination. But even diminished benefit from the vaccine will add some armor against the virus’ spike protein.
From the diagnosis and beyond, the fate of many cancer patients is closely linked to the course of the infection.