COVID-19 has caused 475,000 deaths in America, disproportionately among communities of color, poverty, immigrants, and older age. It has exposed a variety of inequities within our health-care system. However, the patients at greatest risk of death from COVID-19 are those with cancer. While 1.8% of Americans with COVID-19 have died,1 those in long-term care facilities have had a 12% mortality,2 and 26% of patients with cancer who contracted the disease have died from the virus.3 Certainly patients with cancer should be prioritized in getting vaccinations.
This is personal: As a three-time cancer survivor and a doctor who has cared for patients with cancer for over 40 years, I have experienced and seen the suffering cancer can visit upon patients and their families. Now that vaccines are available, this vulnerable population should be just below health-care workers and first responders in eligibility.
The pandemic has impacted patients with cancer, not only in causing morbidity and mortality, but also in the reduction of the scientific advancement of early diagnosis, treatment, and cure.— Richard J. Boxer, MD, FACS
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Beyond Morbidity and Mortality
The pandemic has impacted patients with cancer, not only in causing morbidity and mortality, but also in the reduction of the scientific advancement of early diagnosis, treatment, and cure. The extraordinary and appropriate focus and achievement of medical science to develop a vaccine against COVID-19 graphically demonstrate the genius of researchers, but that focus has also diverted investigators from potential discoveries beneficial to patients with cancer. Now is the time to refocus, with increased funding in clinical and basic science research in cancer, the leading killer of Americans, second only to heart disease.
Further, because of the pandemic, breast cancer screenings dropped by 89.2% and colorectal cancer screenings dropped by 84.5% in only 5 months.4 Overall, the decrease in standard cancer screening resulted in a 65.2% drop in new cancer diagnoses. More than 22 million screening tests that might have been anticipated in the first half of 2020 in the United States were delayed due to COVID-19.5
The Director of the National Cancer Institute estimates that an additional 10,000 Americans will die in the next 10 years because COVID-19 prevented early diagnosis and led to undertreatment of breast and colorectal cancers.6 That said, this model did not include other cancers, the effects of metastatic advancement due to delays, or a disruption in care lasting for more than 6 months.
The death rate from cancer in the United States declined by 29% from 1991 to 2017, including a 2.2% drop from 2016 to 2017, the largest single-year drop ever recorded, according to annual statistics reported by the American Cancer Society.7 But underfunding and the diversion of focus may change that trajectory.
Research Funding Shortfalls
The achievement of the world’s research scientists in 2020 demonstrates that when governments and pharmaceutical companies commit unlimited money and effort into solving a medical problem, cures are possible. Although the funding from the federal government has not abated, the American Cancer Society predicts a $200 million reduction in philanthropy,8 Great Britain’s shortfall is $150 million,9 and Canada’s is $100 million, plus European Union support has been reduced by 30%—approximately $365 million—with predictions of a $9.5 billion shortfall in the next 6 years.8
These deficits will result in hundreds of researchers, particularly young investigators, not being funded. The loss of funds will take years to make up, and the potential loss of young investigators’ discoveries may be catastrophic. Moreover, the shortfalls in other countries will have a direct effect on Americans: in the past 120 years, 212 scientists have won the Nobel Prize in Medicine—110 from Europe, and 102 from the United States. We have a vested interest in European discoveries.
In the next stimulus package or budget, a line item of additional billions should be designated for cancer research, both in the United States and Europe, to make up for the loss of funding and to encourage the kind of Herculean effort witnessed in Operation Warp Speed—but for cancer research. What better way of sending a message to the world that there is a new American direction than to help researchers throughout the world?
The pandemic is calamitous, but in 2020, 606,520 people died of cancer in the United States,10 nearly 200,000 more than have died of COVID, and this occurs annually. We can wear a mask, socially distance, and wash our hands to reduce the risk of COVID-19, but only research will bring us closer to early diagnostic testing, curative treatments, and prevention of cancer.
Originally published in Real Clear Policy, January 25, 2021 (www.realclearpolicy.com).
Dr. Boxer is Clinical Professor at the David Geffen School of Medicine at UCLA and a Former Member of the National Cancer Advisory Board and National Board of Advisors, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health.
DISCLOSURE: Dr. Boxer has been employed by Boxer Health Strategies, iAnthus Capital, and Veterans Affairs; has served in a leadership position for iAnthus Capital and Joylux; holds stock or other ownership interests and consults for iAnthus Capital, Ceevra, Joylux, Minded, Pager, SirenMD, Tendaji, Veterans Affairs, and Wanderly/Avenue; and has been reimbursed for travel, accommodations, or other expenses by Boxer Health Strategies, Ceevra, iAnthus Capital, Joylux, Minded, Pager, SirenMD, Tendaji, Veterans Affairs, and Wanderly/Avenue.
Disclaimer: This commentary represents the views of the author and may not necessarily reflect the views of ASCO or The ASCO Post.
REFERENCES
1. Johns Hopkins University of Medicine: Coronavirus resource center: Mortality analyses. Available at https://coronavirus.jhu.edu. Accessed February 9, 2021.
2. Kaiser Family Foundation: State COVID-19 data and policy actions. Available at https://www.kff.org. Accessed February 9, 2021.
3. Saini KS, et al: Mortality in patients with cancer and coronavirus disease 2019: A systematic review and pooled analysis of 52 studies. Eur J Cancer 139:43-50, 2020.
4. London JW, et al: Effects of the COVID-19 pandemic on cancer-related patient encounters. JCO Clin Cancer Inform 4:657-665, 2020.
5. COVID-19 and the U.S. health insurance conundrum. Lancet 21:733, 2020.
6. Sharpless NE: COVID-19 and cancer. Science 368:1290, 2020.
7. American Cancer Society: Facts & Figures 2020 reports largest one-year drop in cancer mortality. Available at https://www.cancer.org. Accessed February 9, 2021.
8. Tsagakis I, Papatriantafyllou M: Safeguarding cancer research funding by European charities amidst the COVID-19 pandemic. Mol Oncol 14:2987-2993, 2020.
9. Burki TK: Cuts in cancer research funding due to COVID-19. Lancet Oncol 22:E6, 2021.
10. National Cancer Institute: Cancer stat facts. Available at https://seer.cancer.gov. Accessed February 9, 2021.
