The lockdown phase of the coronavirus (COVID-19) pandemic and continued measures, such as social distancing, while necessary, are disrupting cancer care in ways that will have consequences for months, if not years, to come. Studies are showing that delayed or suspended cancer treatments, screenings, clinical trials, and research will undoubtedly lead to a tragic rise in late-stage diagnoses and long-term mortality rates.1
In many low- and middle-income countries, the spread of the COVID-19 pandemic has made it difficult to conduct essential community outreach and pursue cancer prevention campaigns, such as human papillomavirus (HPV) vaccinations and screening. Patients may be finding it difficult to travel to treatment centers and, in many cases, must overcome fears of contracting the coronavirus if they do so. Caregivers and medical staff face shortages of medication and protective gear.
Princess Dina Mired
It is difficult for patients, their families, doctors, and nurses to deal with cancer in “normal” times. To do so in the time of a pandemic makes it truly heroic. Our cancer community is rising to the challenges, innovating and adapting2 in ways we can only admire and applaud. Members of the Union for International Cancer Control (UICC) have been sharing the incredible responses3 of the medical community, and their individual and collective efforts to ensure the continued delivery of cancer care are an inspiration.
The pandemic has also accelerated positive technologic changes in terms of telemedicine, e-prescriptions, or virtual support groups, which are enabling cancer organizations to design more effective responses to delivering cancer care during the pandemic. We must ensure, however, that these developments lead to better and more equitable access to health care for all, rather than exacerbate the inequity in health-care delivery between young and old, rich and poor, those who have access to higher education and those who do not, and those who are integrated in the formal economy and those who are excluded from it.
Using Lessons Learned From COVID-19 to Improve Access to Cancer Care
We in the cancer community have long known about disparities in the supplies of protective equipment and essential medicines, financial accessibility and availability of trained staff and resources, the efficiency of delivery systems, and the existence of a unified political will to ensure that all individuals have access to adequate health care. It has taken a global pandemic to “unmask” these truths for those who have never needed to question the availability of adequate health care. Yet we must be hopeful that this new awareness will shake a sometimes despairing apathy toward taking real steps to reduce the cancer burden—a disease that globally now causes nearly 10 million deaths annually.4
We must believe there will be concerted efforts to prevent cancer when it can be prevented, through reliable information and widespread access to vaccination and screening programs. And there will be a joining together of forces to ensure that effective treatment and an adequate supply of medication will be available to all those who need them, particularly in low- and middle-income countries, but also for many vulnerable populations in wealthy nations. It is possible. The coronavirus pandemic has shown how government authorities, health experts, and the general public can mobilize in response to a public health crisis—and as the second cause of death worldwide after heart disease, cancer is indeed a public health crisis.
“Our cancer community is rising to the challenges [of COVID-19], innovating and adapting in ways we can only admire and applaud.”— Princess Dina Mired
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Reducing Deaths From Preventable Diseases
It is not the only example.The world has managed to eradicate smallpox and is now one step closer to eliminating polio. Just this past August, Africa was certified free of wild polio,5 making it the fifth of six World Health Organization (WHO) regions to be declared polio-free. Yet 25 years ago, polio paralyzed some 75,000 children each year on the continent. Although efforts to address polio started earlier, the impetus for global action came in 1988, when the World Health Assembly endorsed a resolution to eradicate polio worldwide by the year 2000.6 The timeline may have been ambitious, but the ultimate goal has nearly been achieved.
There is now the same promise for cervical cancer. In August this year, WHO adopted a resolution7 that provides a roadmap to eliminating cervical cancer within a few generations, including targets for countries to reach by 2030. Every 2 minutes a woman dies of this disease, with 90% of the cases occurring in low- and middle-income countries.8 This is largely due to poor access to screening and early detection and treatment, as well as limited vaccination programs against HPV, the primary cause of cervical cancer. WHO’s global strategy toward the elimination of cervical cancer as a public health problem aims to deliver in all these areas.
So, this historic commitment by the global community—made even as countries struggle to contain the spread of COVID-19—is a promise that millions of women will not die of a preventable disease. It also represents a major step in addressing inequities in health care: between men and women, developing and developed nations, communicable and noncommunicable diseases.
It is now up to us—individuals, cancer advocates, and public authorities at all levels of government as well as international organizations—to ensure these commitments translate into actions and results and promises are fulfilled. It can be done.
Her Royal Highness Princess Dina Mired of Jordan is President of the Union for International Cancer Control.
Disclaimer: This commentary represents the views of the author and may not necessarily reflect the views of ASCO or The ASCO Post.
DISCLOSURE: Princess Dina Mired is President of the Union for International Cancer Control.
REFERENCES
1. Maringe C, Spicer J, Morris M, et al: The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: A national, population-based, modelling study. Lancet Oncol 21:1023-1034, 2020.
2. Union for International Cancer Control: Cancer and coronavirus resources. Available at www.uicc.org/resources/access-all-resources/cancer-and-coronavirus-resources. Accessed September 20, 2020.
3. Union for International Cancer Control: Addressing the challenges to the cancer community raised by COVID-19. Available at www.uicc.org/news/addressing-challenges-cancer-community-raised-covid-19. Accessed September 20, 2020.
4. World Health Organization: Cancer Key Facts. Available at www.who.int/news-room/fact-sheets/detail/cancer. Accessed September 20, 2020.
5. World Health Organization: Africa kicks our wild polio. Available at www.africakicksoutwildpolio.com. Accessed September 20, 2020.
6. World Health Organization: Polio Global Eradication Initiative. Available at http://polioeradication.org/tools-and-library/policy-reports/declarations-and-resolutions. Accessed September 20, 2020.
7. Union for International Cancer Control: A historic milestone in the global movement to eliminate cervical cancer. Available at www.uicc.org/news/historic-milestone-global-movement-eliminate-cervical-cancer. Accessed September 20, 2020.
8. World Health Organization: WHO leads the way towards the elimination of cervical cancer as a public health concern. Available at www.who.int/reproductivehealth/cervical-cancer-public-health-concern/en. Accessed September 20, 2020.
