Coronavirus Could Upend Cancer Trends in the U.S.

Protecting patients from getting exposed to the virus also guides some of her decisions around how to provide chemotherapy. “If I have a choice between a [chemotherapy] drug that is given every week and a similar one that is given every three weeks, I now routinely use the one that’s given every three weeks,” she says. “Even if there are a few more side effects, if it reduces the number of times a patient has to come in, then this is a conversation I’m having with them.”

Similar adjustments are possible for radiation treatment in some cases. Normally, radiation therapy is broken up into smaller, daily fractions in order to preserve the healthy tissue around cancers from the toxic effects of single blast. For breast cancer patients, recent, albeit early studies that followed patients for five years, suggested that significantly shorter courses of treatment—given over five days compared to 30, for example—could be equally as effective in controlling the cancer. “Typically we wouldn’t embrace [such early results] in daily practice as quickly as we did except for the pandemic,” says Dr. Reshma Jagsi, deputy chair of radiation oncology at the University of Michigan. “But some patients were willing to take the risk of not having long term evidence on the safety and trust the five year data which was certainly compelling and intriguing.”

For the most part, cancer patients have understood the importance of continuing their treatment and of balancing their risk of cancer against their risk of getting COVID-19. In fact, says Busby, “it’s not so much our patients we worry about but the patients who are not ours yet.” Most hospitals canceled routine cancer screening appointments for things like mammograms and colonoscopies, which are essential for detecting cancer early. And many people who might have potential cancer symptoms and aren’t diagnosed yet, aren’t going to the doctor because of COVID-19 fears. If that’s the case—and only data on cancer rates in the coming months and years will provide the answer—it’s possible that both the number of new cancer cases and their severity will increase as a result of the pandemic.

“My concern is for the patients who have not yet been diagnosed with cancer; for those patients who delayed their screening; for patients who put off being examined for certain symptoms,” says Jagsi. “Those patients will be diagnosed at later stages and I do have great concern there that will change cancer-related treatment outcomes.” In recent years, advances in screening have helped doctors more regularly diagnose patients at earlier stages where their disease is still treatable and curable, Jagsi notes. “I fear that some COVID-19-related delays may compromise some of the advances we have seen.”

How deeply COVID-19 will cut into those gains won’t be clear until more data on new cancer cases becomes available in coming months. But most experts agree that “it’s hard to imagine that the pandemic would contribute to a better situation; it’s going to have to be worse,” says Carey.

In the meantime, patients are learning to accept the adjustments they need to make to ensure their treatments continue with as little disruption and in the safest way possible. Satterfield has had two COVID-19 tests because the chemotherapy she receives gives her a runny nose, cough and diarrhea—all symptoms of COVID-19 that are flagged when she is screened before entering the cancer center for her treatments. But she’s okay with that, and understands why it’s needed. For her, “the most challenging part is emotional. With any terminal illness, it’s there—I think, is this the way the world is going to be when I die? Is this how I see the end of my life? But I’m feeling better than I have in recent memory. As much as my health status doesn’t sound great, I feel great. And I’m thankful for that.”