Ned Sharpless is worried.
The director of the National Cancer Institute believes the Covid-19 pandemic is posing a danger to cancer patients across a wide spectrum of care and research. People — and their health care providers — are postponing screening measures like mammograms and colonoscopies. Fewer cancers are being diagnosed, and treatment regimens are being stretched out into less frequent encounters. Clinical trials have seen patient enrollment plummet.
An NCI model looking just at breast cancer and colorectal cancer predicts there will be 10,000 excess deaths in the U.S. over the next 10 years because of pandemic-related delays in diagnosing and treating these tumors. That’s about a 1% increase over the number of expected deaths during that time span, with most of the rise coming in the next two years. And that assumes cancer care depressed by the coronavirus rebounds after six months.
“We think that [mortality] estimate we provided is very conservative and likely to grow if we continue to postpone screening treatment and other cancer care,” Sharpless told STAT. “We’re very worried about the consequences of … delaying therapy on our patients.”
Now is the time to reopen cancer care, Sharpless said. Hospitals that are now seeing fewer Covid-19 patients are beginning to ramp up care and patients shouldn’t be afraid to go there, if they observe reasonable precautions, he said.
“Clearly, postponing procedures and deferring care as a result of the pandemic was prudent at one time, but the spread, duration, and future peaks of COVID-19 remain unclear,” he wrote in an editorial published in this week’s Science. “However, ignoring life-threatening non-COVID-19 conditions such as cancer for too long may turn one public health crisis into many others. Let’s avoid that outcome.”
What if states’ decisions to reopen and relax social distancing measures drives another surge in Covid-19 cases?
“We now have a lot more experience than we did a few months ago, starting to understand its route of transmission and patterns of spread,” he said in the interview. “I think now we can be judicious in the use of testing and mask wearing and good social distancing and certain [other] behaviors.”
What if there’s a second wave in the fall?
“We can open hospitals and worry about a second wave. I think it’s possible to do both. We have to,” he said. “To do otherwise, we’re going to trade different public health emergencies. So I think we can’t delay cancer care forever.”
NCI estimates a drop of 75% in mammograms since March, which may be conservative, Sharpless said, compared to the 95% cited by Epic, the electronic health records vendor. Whether “upstaging,” the term for diagnosing cancer at a later stage, will become a problem depends on the cancer. Some cancers are called indolent because their growth can be slow enough that a three- or six-month delay won’t matter. But in lung cancer, for which there is no screening equivalent to mammography or colonoscopy, even a month’s delay can be harmful.
“Three months is a lot of time and six months — well, then you start to see a 1% increase in mortality,” he said.
Certain adaptations made by hospitals treating cancer patients and researchers running cancer clinical trials could continue, including telemedicine visits for some care and oral consent over the phone rather than in person to participate in trials.
“The coronavirus pandemic is a public health event that everyone should be worried about and should behave appropriately, including people who run hospitals. They need to preserve capacity and take a proper pandemic response,” Sharpless said. “But the things we do to diminish our risk are not without impact on other areas. Public health and cancer outcomes are inextricably linked.
“We have to realize the tradeoffs we make when we work on one versus the other and find that right balance.”