The COVID-19 pandemic made landfall in North America like a hurricane, leaving a trail of devastation for years to come. In an effort to gauge the impact of the pandemic on cancer and guide future healthcare decisions, a team of physicians, statisticians, data analysts and epidemiologists have joined forces to create the McGill Task Force on the Impact of COVID-19 on Cancer Control and Care.
Taking a pause
“The whole world of oncology has been upended by the pandemic,” reflects Dr. Eduardo Franco, Chair of the Gerald Bronfman Department of Oncology at the McGill Faculty of Medicine. Dr. Franco spearheaded the creation of the Task Force in the early months of the pandemic as the dramatic decline in cancer screening, treatment, and surgery became apparent.
As hospitals became hot zones for COVID-19, patients opted to postpone appointments for preventative mammograms, pap smears, prostate exams and colorectal screenings. In many cases, they didn’t have a choice as hospitals diverted personnel to COVID-19 treatment and scrambled to adjust to a new reality. In public schools, children who would have received HPV and hepatitis vaccines this year are still unvaccinated, opening the door to greater risk decades down the road.
On the treatment side, patients who had already received a cancer diagnosis before COVID-19 face a limited set of options. Many cancer treatments render patients more immunologically vulnerable, so healthcare providers have adapted treatment schedules to reduce hospital visits. “The problem is that these substitute treatment regimens are less effective,” says Dr. Franco. With time, he believes, the cancer cases that are not detected or treated now will lead to more severe outcomes in the future. “Without a doubt, we will pay a price.”
The price of delay
Dr. Wilson Miller, a McGill professor and oncologist who was selected by Dr. Franco to lead the Task Force, has already witnessed the impact of delayed and cancelled cancer-related appointments firsthand. “Within a span of several weeks, I saw three patients with undiagnosed, highly advanced cancer,” he shares. “Previously, I would only see cases like these once a year.”
Under Dr. Miller’s leadership, the 35 members of the Task Force, many drawn from the Rossy Cancer Network for which he served as Lead Clinician, are single-mindedly focused on measuring the impact of delays in cancer screening and treatment in a variety of scenarios. Though the medical literature on the impact of COVID-19 on cancer is sparse, they are carefully reviewing what exists and conducting surveys of specialists across Canada to make their own contribution.
Funded in part by a grant from the Canadian Institutes of Health Research (CIHR), the Task Force has focused first on cervical cancer as it gathers data related to screenings and outcomes. The team’s data analysts and mathematicians have already begun to use the data collected to model pre- and post-COVID-19 survival rates. “We want to reach the point where we can determine that if a patient postpones their surgery for ‘x’ amount of time, their chances of survival are decreased by ‘y,’” explains Dr. Miller. “If we can determine which delays have the most adverse effects on patients and projected outcomes, we can help our cancer departments know which services to prioritize.”
In addition to surveying specialists and projecting outcomes, the Task Force is also working to take inventory of projects across the McGill oncology ecosystem that touch on both cancer and COVID-19. “Our goal is to create new linkages so that no one is working in a silo and we can effectively identify areas where more work is needed,” says Dr. Miller.
Ensuring a safe return
As the Task Force works to provide evidence-based guidance for the resumption of cancer-related services, its members are passionate about conveying a message to the public. “Hospitals may be hotspots for COVID-19, but oncology wards are not,” emphasizes Dr. Miller. “We’re open for business and doing everything we can to keep patients safe.”
Dr. Franco acknowledges the dilemma many patients face in making healthcare decisions in an environment of crushing uncertainty. “We recognize that patients are genuinely concerned as they try to balance risk,” he notes. “On the other hand, it’s clear today that the risk of not being diagnosed and not being treated for cancer is worse than the risk of catching COVID-19. Cancer doesn’t wait. We must act now to prevent further damage.”