With the ongoing fight against the COVID-19 pandemic, The American Association for Cancer Research (AACR) held a three-day virtual event from July 20th-22nd with a series of presentations and talks regarding the most up-to-date research on COVID-19 and the unprecedented impact it has had on cancer research and care.
The rapid spread of coronavirus across the globe has resulted in a sudden pause on day-to-day life. Strict lockdown rules have been enforced, healthcare services overwhelmed and communication with loved ones restricted. As we look to the future, many have started to question the long-term impact that this pandemic will have, not only on the economy, but also on public health.
To control the spread of the virus, many countries were initially forced to seize non-essential healthcare services with research shifting its focus onto understanding and combatting the virus. In turn, this resulted in disruptions to cancer research, clinical trials and treatment. Furthermore, many patients fear returning to a healthcare setting for screening, diagnosis or treatment and the true impact of the pandemic on mental health remains uncertain.
The COVID-19 and Cancer meeting commenced with a keynote address from the Director of the National Institute of Allergy and Infectious Diseases, Anthony Fauci, who immediately established that this virus is “much more than just a common cold.”
More than just a common cold
Originating in bats, COVID-19 is caused by a novel beta coronavirus SARS-CoV-2, named due to its phylogenetic proximity to the original SARS coronavirus which emerged in 2002. It is an enveloped, positive-sense, single-stranded RNA virus that contains several structural proteins – the most important being the S protein that allows the virus to enter the host cell and is the target for several vaccine trials. Unlike previous coronaviruses, SARS-CoV-2 has fascinated the academic community due to its wide spectrum of disease. Whilst some individuals can develop severe symptoms that result in hospitalisation and/or death, 20 to 40% of people with the disease are completely asymptomatic.
In his keynote address Fauci then turned his focus to the reduction in cancer screening and treatment caused by COVID-19 and referred to an editorial published in Science by Norman E Sharpless, Director of the National Cancer Institute. It is predicted that over the next decade, as a result of this reduction in cancer screening and treatment, there will be an excess of 10,000 deaths from breast and colorectal cancer alone. This prediction marks a call to action for healthcare providers, researchers and leaders to investigate the impact of COVID-19 on cancer care in order to implement strategies that will hopefully avoid this outcome.
The series of talks and presentations hosted by AACR highlighted some of the issues facing cancer care and drew upon ways to continue monitoring and treating cancer patients during these tentative times.
The impact of coronavirus on cancer patients
The coronavirus pandemic and the overwhelming demand on healthcare systems has ultimately led to a direct impact on cancer care in many hospitals. During his talk on ethics, cancer and COVID-19, Arthur Caplan – Head of the Division of Medical Ethics at NYU Langone Medical Center – described the beginning of the pandemic and how the pressure on hospitals resulted in a shift of resources and personnel to meet intensive care unit demands. As a result, all non-essential services were postponed.
To adapt to these circumstances many healthcare professionals have turned to Telehealth – technology that enables healthcare professionals to remotely communicate with their patients. The transition to Telehealth-based communication has also extended to cancer support groups, which have in fact seen an increase in participation according to Laura Esserman, Professor of Surgery and Radiology at University of California, San Francisco. A recent survey by the Sidney Kimmel Cancer Center in Philadelphia looked at the impact of the pandemic on cancer patients, survivors and caregivers, and found that 76% of cancer patients had no problem with using Telehealth to talk to their healthcare professional. Nonetheless, within this same study, it was reported that 63% of respondents were somewhat or very much worried about getting coronavirus.
The long-term impact of coronavirus on mental health cannot be fathomed, particularly amongst high-risk groups. There are several factors found to increase risk and severity of coronavirus infection, most notably, increased age, gender, health co-morbidities and race/ethnicity. Several studies have reported an alarming disproportionate rate of hospitalisation and death of individuals from ethnic minority groups. John Carethers, Professor and Chair of the Internal Medicine Department at the University of Michigan, addressed this disparity as he discussed the consequences of socioeconomic inequalities. He explained that these consequences, such as a low-income job, can lead to co-morbidities that in turn increase risk of COVID-19 severity. The recent COVID Symptom Study, which has attempted to track coronavirus hotspots in real time across the UK and USA, has reinforced this racial disparity. David Drew, Instructor of Medicine at Harvard Medical School, reported how they found “a greater than two-fold likelihood of reporting being COVID-19 positive among minority groups, and the highest risks observed among black individuals.” They also observed an increased risk of ~88% for testing positive for COVID-19 among app users with cancer, with those receiving chemotherapy and/or immunotherapy having a two-fold increased risk of COVID-19 and COVID-19-related hospitalisation. Drew went on to discuss the importance of expanding the distribution of the app to ensure that more ethnicities are represented in the data, beginning with its recent release in Spain.
How can we help cancer patients going forward?
As services begin to slowly resume, many have expressed their concerns about patients not returning to healthcare environments due to fear. Patricia Spears, Scientific Research Manager and Patient Advocate at the University of North Carolina, provided her thoughts on how to combat these issues during one of the sessions. She emphasised that nobody is aware of the exact impact that the interruption of treatment will have on the long-term outcome for patients, but suggested that communication is vital going forward:
“Emotional support, I think, is going to be critical in getting patients back to the clinic and just keeping that communication open, so you know where the patient is coming from and the physician is coming from.”
Within the session, the importance of continuing to adapt services and organisations during these unusual times was discussed, for example, the continued use and development of Telehealth. With this, there needs to be continued effort to educate both the healthcare community and patients, promoting appropriate use of protective measures and reassuring patients that healthcare environments are safe. Josep Tabernero, Head of the Medical Oncology Department at Vall d’Hebron University Hospital, stated:
“We have to protect ourselves and our patients continuously.”
The need to invest in the future of cancer research and thus the future of cancer care was clear. Nancy E Davidson, President and Executive Director of Seattle Cancer Care Alliance, expressed that resuming clinical trials was key for moving forward:
“One of the things that brings our patients to the clinic, in addition to their need for standard therapy, is the access to clinical trials – to the treatment of the future.”
Whilst the battle against coronavirus remains in the spotlight, the long-term battle against cancer has continued to simmer under the surface. With the future of COVID-19 still unclear, we must remember that neglecting our battle against cancer, may in turn result in a war with many more causalities.
Fauci reminded us of this when he concluded his keynote address:
“We’ve always had emerging infectious diseases. We have them now, and we will continue to have them in the future. Just as emerging infections provide for us a perpetual challenge, we need to be perpetually prepared.”
Image credit: Background photo created by kjpargeter – www.freepik.com