Three experts discuss the long-term effects of the coronavirus pandemic on cancer care.
Editor's note: Responses have been edited for clarity and length and are presented alphabetically.
Question: What are your biggest concerns with regard to the lasting effects of the COVID-19 pandemic on cancer care?
Matt Kalaycio, MD, vice chairman of Cleveland Clinic Taussig Cancer Institute
My biggest concern for cancer care in a post-pandemic world is disparities in care. The pandemic has already caused delays in screening and treatment. While these effects may lessen with the passage of time, the effects on the economy will be sustained. A weak economy with high unemployment will mean fewer financial resources for the most vulnerable patient populations, leading to worsening disparities of care. Lack of financial security may cause patients to delay or decline lifesaving treatment, even after the pandemic itself has passed. As the cost of cancer care rises, these concerns will become more and more pressing.
Shalini Kanneganti, MD, colorectal cancer surgeon with CHI Franciscan in Tacoma, Wash.
Cancer screenings are critical. We've seen that patients are often hesitant to receive screenings and postpone appointments out of fear of COVID-19. The fact is, the longer someone goes without a screening, the worst a condition could potentially get. My hope is that this does not become a lasting effect of the pandemic, and patients continue regular screening routines before presenting with more advanced diseases.
Derek Raghavan, MD, PhD, president of Levine Cancer Institute in Charlotte, N.C.
The COVID19 pandemic is likely to have a mixture of positive and negative long-term consequences. On the positive side, it has reaffirmed for many healthcare workers their true mission, has brought out heroism, dedication and refocused our intent to improve the situation of patients and their families. Many healthcare workers have shown amazing courage, and many have lost their lives in battling this virus with inadequate equipment and resources. It has also shown us that some of our work can be done from home, and that a proportion of patients actually prefers virtual consultation where they don't need to leave home, dress up, get transport and — sometimes — wait for the interaction. It seems likely that routine commuting will not be needed in the long term, with some clinical work, particularly in the area of survivorship and long-term follow-up, will be carried out virtually.
Unfortunately, there is also a negative side to the pandemic, beyond the obvious loss of life and long-term medical consequences of COVID-19. The situation will be similar to the financial recession in 2008, wherein many people lost employment and health insurance and thus delayed healthcare, resulting in delayed presentation, and sometimes consequently premature death, with many health conditions — heart disease, cancer, diabetes, hypertension and many others. Thus, following 2008, it was noted internationally that the stage of many cancers at presentation was increased, and this was accompanied by a transient increase in cancer-related morbidity and mortality.
It should be noted that the negative consequences of virtual consultation are not yet known, and it may be that the absence of in-person assessment and the actual physical examination will lead to missed diagnoses and consequently delayed treatment with much worse outcomes.
Finally, many healthcare workers have been particularly disappointed at the lack of common sense of national political leaders, the multiple failures of the CDC and FDA, the politicization of social distancing and masking, the selfish refusal to mask, especially in young party attenders, and the apparently aggressive resistance in some community domains directed toward science and healthcare. This recollection will not rapidly dissipate.