The unintended impact of COVID-19 on cancer

Over the last few months, many patients have been in fear of their cancer journey. This fear had nothing to do with receiving their diagnosis or walking into a screening because of a found lump or increased risk. It wasn’t about dealing with the side effects of their chemotherapy, surgery, or radiation treatment. And, it was not caused by the stress felt when waiting for results from a significant medical test or scan. The fear was caused by our country’s myopic focus on flatting the COVID-19 curve. While we may have successfully flattened the proverbial curve, we have created a potentially larger, more dangerous shadow curve in the world of cancer. 

In April 2020, the IQVIA Institute for Human Data Science published a report that shined a light on the unintended impact of our response to the threat of COVID-19.  According to the report, it is estimated that the delay in 22 million cancer screening tests will result in an increased risk of delayed or missed diagnoses for 80,000 patients.  

While COVID-19 exposed some major vulnerabilities in our health care infrastructure, most notably, the system’s ability to continue to care for every high-risk chronic health care case— such as cancer and heart conditions— when other aspects of our health care system were overwhelmed by an unpredictable health care crisis. The long-term implications may be devastating, particularly if we do not recognize and address the looming Cancer Shadow Curve, a dramatic spike in undiagnosed and untreated cancer cases as a side-effect of the pandemic.

So where are we after the health care system essentially placed cancer care on hold for three months? 

The U.S. has already witnessed a 37 percent drop in cancer care diagnosis compared to this same time period last year, and we have experienced massive drops in cancer screenings including mammography (87 percent drop), colonoscopy (90 percent drop) and Pap Smear (83 percent drop).

Doctors find a lot of cancers during screenings— and much more incidentally as they meet with patients for non-cancer examinations. Typically, there are nearly 1.8 million cases of cancer diagnosed each year, but people who have skipped appointments over the last three months are not getting diagnosed. That is a major concern.

If people wait until next year to get screened, their undiagnosed condition may worsen, even if cancer remains treatable. That can lead to dramatically worse consequences to their quality of life for years, particularly if, during that time, their cancer progresses from Stage 2 to State 3 or 4. From the “Shadow Curve” perspective it means the health care system will start to see an influx of very difficult to treat cancer cases all at once instead of doctors being able to address cancers during more treatable stages, giving them more opportunities to find the right solutions. 

So, what can we do to help people immediately and prepare the system for the future?

Right now, patients need to restart their cancer prevention screenings, treatments and surgeries. The cancer isn’t going to wait for COVID-19 and neither should you.

In planning for the future, the health care system needs to fix what is broken, now. Shame on COVID for fooling the system once, but shame on us if the system isn’t better prepared if COVID-19 or another pandemic-like scenario hits our country. 

First, we cannot have a one-size-fits-all monolithic policy. Asking cancer patients to curl up under the covers at home and wait instead of getting their necessary treatments is just bad medicine. Instead, we need to have systemic protections that shift high-risk patients to singular care facilities that isolate them from a pandemic instead of isolating them completely from their cancer treatments. 

Second, we need to ensure the patient’s care team can follow them to the singular care facility so those patients can maintain their continuity of care. As health care professionals, it’s our responsibility to solve these types of administrative problems, not the patients. 

Last, and maybe most important, we need a system that can suspend insurance bureaucracy during a pandemic-like situation. It’s not acceptable for a patient’s care to be put on hold because an available treatment center isn’t “in-network.” In these situations, insurance should default to an established reimbursement structure that is automatically implemented so the patient can continue care anywhere.

Three years into the future researchers may look back at the pandemic and discover that deaths from undiagnosed conditions— such as cancer, heart attack, stroke or mental health— were as or more pervasive than COVID-19 itself. We can prevent that study from being written, and that starts by maintaining the patient’s continuity of care and strengthening our approach before the cancer shadow curve has a chance to overwhelm the health care system.

 Pat A. Basu is the president and CEO of Cancer Treatment Centers of America Global Inc. (CTCA), a national oncology network of hospitals and outpatient care centers. Prior to joining CTCA, Basu served as a White House fellow and senior adviser and played a key role in helping execute portions of then-President Barack Obama’s economic and health agenda.