COVID Fears Mean More Cancers Are Being Diagnosed at Later Stages
Cancer screening rates are beginning to rebound after plummeting during the first year of the coronavirus pandemic, a new survey finds.
And patients are being diagnosed with more advanced cancers than before the pandemic, according to the American Society for Radiation Oncology (ASTRO).
"The trend toward more advanced disease, while alarming, does not automatically mean worse outcomes for patients," ASTRO's chairman, Dr. Thomas Eichler, told reporters during a briefing on Tuesday. "Modern treatments, such as stereotactic radiation therapy or immunotherapy drugs, may offset some of the threat from advanced-stage cancers."
On the plus side, patients are no longer putting off treatment, and clinics continue to use COVID-19 safety measures to protect patients and staff, Eichler said.
In all, 117 U.S. doctors completed the survey.
Two-thirds of the radiation oncologists said new patients are being diagnosed with more-advanced cancers and 73% said patients are not receiving cancer screenings. Two-thirds also said patients had interrupted radiation treatment due to the pandemic.
As more patients are being vaccinated against COVID-19, masks, social distancing and coronavirus screening are nearly universal at radiation therapy clinics. Many are beefing up sterilization procedures, having staff wear face shields and banning visitors, Eichler said.
The survey also found that most clinics have stopped postponing or deferring radiation treatments. Only 15% said they postponed treatments in January and February of this year, compared with 92% in April 2020. And 12% have deferred new patient visits this year, compared with 75% in the pandemic's first weeks, the survey found.
Despite these dramatic changes, four in 10 clinics said they have had trouble getting personal protective equipment, hand sanitizer or other supplies this year. Fifty-three percent said vaccination efforts were hampered by access to shots and by vaccine-reluctance among staff (59%) and patients (52%).
These issues were more acute at rural and community clinics than in urban and academic settings, Eichler said.
The survey also looked at trends in telemedicine. The researchers found that 85% of clinics offer telemedicine options for follow-up surveillance visits, and 54% do so for new patient consultations.
The online survey was conducted from Jan. 15 through Feb. 7, 2021.
"We were certainly seeing individuals delay coming in for radiation because of concerns related to COVID," Dr. Karen Winkfield, executive director of the Meharry-Vanderbilt Alliance in Nashville, Tenn., said at the news conference. "But we have done a wonderful job in radiation oncology departments around the country with making sure our patients and our staff are safe."
Patients are also returning for cancer screening, Winkfield added.
Shelley Fuld Nasso, chief executive officer of the National Coalition for Cancer Survivorship, in Silver Spring, Md., said while telemedicine has proved important, many patients lack access or the ability to use the technology needed.
For many patients, telemedicine creates a feeling that needed emotional support has been lost, along with a sense of isolation and limited access to the cancer care team, Nasso said.
"We heard from patients that they want to be able to have access to the whole team and not just the one person they may be seeing on telehealth," she said.
Nasso also mentioned two patients whose doctors initially passed off their cancer as something else.
"[These patients] had to be advocates to get their diagnosis -- neither of their cancers would have been detected by screening -- but they knew the symptoms they were feeling were not right and they sought treatment, even as they faced delays in the diagnosis," she said.
Not everyone is willing or able to advocate for themselves, Nasso added.
"We need to ensure that the system works for everyone regardless of their health literacy or their ability to advocate for themselves," she said.
Pandemic-related unemployment and the resulting loss of health insurance have also taken a toll on cancer screening and diagnosis, according to Dr. Laura Makaroff, senior vice president for prevention and early detection at the American Cancer Society.
But Makaroff predicted that as more Americans are vaccinated, increases in screening and cancer diagnoses will follow.
"People will feel more comfortable going in for health care, but I think we as a nation need to also recognize that we have work to do to reduce these barriers so that patients are able to engage in care safely and understand that risk of delaying care or delaying screening is far greater than any risk of potential COVID exposure," Makaroff said.
To learn more about radiation oncology, visit the American Society of Clinical Oncology.
SOURCES: Thomas Eichler, MD, chairman, board of directors, American Society for Radiation Oncology, Arlington, Va.; Karen Winkfield, MD, PhD, executive director, Meharry-Vanderbilt Alliance, Nashville, Tenn.; Shelley Fuld Nasso, MPP, chief executive officer, National Coalition for Cancer Survivorship, Silver Spring, Md.; Laura Makaroff, DO, senior vice president, prevention and early detection, American Cancer Society; American Society for Radiation Oncology survey, March 30, 2021