The Impact of COVID-19 on Cancer Outcomes (and How to Stay Safe)

COVID-19 is a crisis that tragically has claimed the lives of thousands people in the U.S. But cancer and malignant disease will claim the lives of 600,000 people across our country this year. At The University of Kansas Cancer Center, we’ve been balancing these crises daily by treating cancer and COVID-19 with equal vigilance.

We work closely with staff to balance efficiency and safety as we see increasing cancer cases. We are committed to ensuring cancer patients, one of our most vulnerable populations to the novel coronavirus, receive high-quality and timely cancer care in a safe environment.

Cancer patients are uniquely susceptible to infectious diseases like COVID-19, which is caused by the coronavirus. In fact, patients who are in active treatment are at 10 times greater risk of having severe complications from COVID-19. Cancer survivors have a 3-to-4 times greater risk of experiencing severe complications from COVID-19.

Nearly 17 million people in the U.S. are living with cancer. Those who are in active treatment are forced to make difficult decisions weighing their risk of cancer against their risk of getting COVID-19. Studies show that the death rate of cancer patients who become infected with COVID-19 is higher ‒ from 13% to 28% ‒ than non-cancer patients. Still, patients must continue their screening and treatment because cancer doesn’t stop for COVID-19. We don’t want delayed screenings to become another fatal consequence of the pandemic.

A recent survey by the Prevent Cancer Foundation suggests more than 1/3 of Americans have missed scheduled cancer screenings because of COVID-19 fears. Additionally, 43% of Americans have missed medical appointments.

At the cancer center, we’ve seen about a 10% increase in cancer cases. Because routine screening appointments were postponed, and people who may have had cancer symptoms were fearful of getting out of the house for testing, there was a delay in care. But we are busier now than we were pre-COVID-19. We are doing lung cancer screenings, mammograms and colonoscopies ‒ which are essential for detecting cancer early ‒ and finding early cancers, which contribute to the increase in patient volume.

Cancer surgeries have been taking place as they are urgent surgeries. By implementing added precautions to keep patients safe (cleaning and hygiene measures, physical distancing) no cancer patients have been infected with COVID-19.

To keep our patients safe from contracting COVID-19, we rapidly adapted to the changing situation by putting specific protocols in place. We implemented clear infection prevention guidelines (wash hands often, maintain physical distancing of 6 feet, wear a mask) to keep patients and staff safe. All patients, visitors and staff are screened for fever and COVID-19 symptoms prior to entering cancer center locations. We are also screening patients for COVID-19 before their cancer treatments. We also initiated a 1-visitor policy to keep patients and staff safe, and family members could take part in visits by phone or video.

Cancer patients are vulnerable to COVID-19 not only because of their disease and treatment, but because of all the physician/clinic visits they are expected to have outside of their home. Between 10-20% of our patient visits now are conducted through telehealth. Telehealth decreases the number of in-person visits for patients and eliminates time spent in the waiting room or in line without impacting overall care.

The visits are convenient for patients and allow virtual interaction between the provider and the patient. We do a lot of consults, second opinions and exams through telehealth because we know that waiting at home is better than waiting in a clinic. We try to balance the need for patients to come into the clinic against what is best for them. It’s our responsibility to keep our patients, as well as our healthcare workers, healthy.

While telehealth is a silver lining during this tragic time, it also means the interpersonal nature of the provider-patient relationship has changed. When I walk into an exam room, I have a mask on, am fully gowned and wearing gloves. The physical aspect is much different than what we’ve known as typical physician-cancer patient relationship. But despite changes to our protocols, our care and dedication never change. We are all struggling as this new normal is being defined, but we provide onco-psychologists and other touches to help patients feel the interpersonal relationship is still there.

Another step we’ve taken to ensure we stay connected to our patients involves communications through MyChart, the health system’s patient portal. MyChart offers secure online access to a patient’s electronic medical record and allows them to communicate with their care team via secure messaging.

Typically, we track about 600 questions a week from patients through MyChart. That number recently more than doubled so that physicians and nurses receive about 1,300 questions weekly. Our response to those communications is very important, so we challenged ourselves to respond back to patients within 4 hours. Thus far, we have a 90% response rate within 4 hours.

Five months into this global pandemic, there’s a new normal in cancer care. Because of the infection prevention guidelines we put in place (wiping down surfaces, wearing a mask, washing hands frequently), patients know they are in a safe environment. Many of our patients tell us that outside of their home the cancer center is the only place they feel safe. Our measures have allowed us to become more efficient for patients and provide better patient care ‒ a positive out of the crisis.

We have COVID-19 research taking place at the cancer center and have formed a research group that collaborates and takes part in nationwide investigations.

We’re getting patients back on track and are busier than we were before the COVID-19 crisis erupted. This is important, because delays in care could lead to an increase in cancer cases. The National Cancer Institute predicts an additional 10,000 deaths from breast and colon cancers alone over the next decade, as a result of delayed screenings during the pandemic, on top of an expected 1 million cancer-related deaths.

Cancer didn’t listen to COVID-19 and it rages on. We have a crisis, but the cancer center has handled it very well. The crisis is the same for all chronic diseases, as well as the challenges to our health, but we must put these into perspective and not neglect to seek care. This means if you have cancer symptoms, you must have them checked out because they can be more serious than the COVID-19 infection.