Effects of the COVID-19 Pandemic on Cancer Care, Provider Well-Being

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Delays and cancellation of cancer treatments and other safety measures undertaken to minimize the risk of exposure to the coronavirus have generated a backlog in oncology care and research. The threat of delayed diagnoses looms while oncology professionals face burnout, according to new studies discussed at the ESMO Virtual Congress 2020.

“Whether the risk for dark statistics is real or not will only become evident in the future when more robust results from real-world studies and registries are available,” said Stefan Zimmermann, MD, ESMO Press Officer, at the opening press conference of the Congress. “For now, it is legitimate to ask ourselves if there are other factors beyond COVID-19 that currently put strain on oncology, as the pandemic has also revealed some weaknesses in how cancer care is resourced and organized,” he added.

Stefan Zimmermann, MD

Stefan Zimmermann, MD

Prior to the pandemic, Europe’s cancer burden was estimated by the ECIS - European Cancer Information System to reach 2.7 million new cases and 1.3 million deaths in 2020. However, the COVID-19 outbreak has placed unprecedented pressures on health-care systems around the world.

COVID-19’s Effect on Cancer Care Delivery

A study presented by Jerusalem et al (LBA76_PR) at the Congress highlights the extent to which COVID-19 has challenged the organization and delivery of cancer care. Responses were obtained from oncology centers in 18 countries. Overall, 60.9% reported that clinical activity was reduced at the peak of the pandemic, while nearly two-thirds (64.2%) cited undertreatment as a major concern, and 37% expected to see significant reductions in clinical trials this year.

Study author Guy Jerusalem, MD, of Centre Hospitalier Universitaire Sart Tilman, Belgium, said, “COVID-19 has had a major impact on the organization of patient care [and] on the well-being of caregivers and clinical trial activities. There is a risk that the diagnosis of new cancer cases will be delayed and that more patients will be diagnosed at a later stage of their disease.”

The data also revealed that the cancer treatments most likely to have been canceled or delayed were surgery (in 44.1% of centers), chemotherapy (25.7%), and radiotherapy (13.7%), while an earlier end to palliative care was observed in 32.1% of centers.

The impact of COVID-19 on patient care worldwide is also highlighted in another study presented by Jazieh et al (Abstract 1678P), which gathered data from 356 cancer centers across 54 countries during April 2020. The vast majority (88%) reported facing challenges in providing care during the pandemic, with 54% and 45% reporting cases of coronavirus among their patients and staff, respectively. While half (55%) reduced services preemptively, others were forced to do so after being overwhelmed by the situation (20%) or following a shortage of personal protective equipment (19%), staff (18%), and medicines (9.8%).

As a result, 46% of centers reported that more than 1 in 10 patients missed at least one cycle of treatment, with some estimating that up to 80% of patients were exposed to some harm.

To continue providing treatment to patients throughout the pandemic, most centers (83.6%) adapted by implementing virtual clinics and virtual tumor boards (93%), with more than half of respondents suggesting that both will continue beyond the pandemic (55.5% and 60%, respectively). Centers also performed routine tests in laboratories close to patients’ homes (76%) and shipped medication to patients (68%) so that treatment could continue.

Study author Abdul-Rahman Jazieh, MD, MPH, of King Abdulaziz Medical City in Riyadh, Saudi Arabia, said, “The detrimental impact of COVID-19 on cancer care is widespread, with varying magnitude among centers worldwide. The pandemic has impacted health-care systems globally, interrupting care and exposing patients to significant risks of being harmed.”

Effect of the Pandemic on Providers

The results of two online surveys undertaken by the ESMO Resilience Task Force in May 2020 (LBA70)—the largest-ever COVID-19 survey of the oncology workforce—reveal the impact of the pandemic on oncology professionals.

The first survey showed that more than one-third (38%) experienced feelings of burnout and 25% were at risk of distress, while two-thirds (66%) said they were unable to perform their duties as well as they could prior to the pandemic.

This survey, involving 1,520 participants from 101 countries, also found that levels of well-being and job performance declined as national COVID-19 mortality rates rose. A follow-up online survey undertaken in July and August 2020 showed that while job performance had improved compared to the first study, indicating early signals of taking control of the emergency, both well-being and burnout rates had worsened.

The main factors associated with distress and burnout were increased working hours, feeling worried about well-being, less resilience, and oncologists’ concerns about training and career.

Susana Banerjee, MBBS, PhD

Susana Banerjee, MBBS, PhD

“The ESMO Resilience Task Force surveys indicate that COVID-19 is having an impact on well-being, burnout, and job performance,” said Susana Banerjee, MBBS, PhD, ESMO Director of Membership and lead author of the surveys. “As an oncology community, we must work collaboratively, individuals and organizations, to ensure that resources are used in the best way possible to support oncology professionals and make sure that distress and burnout do not increase. The ESMO Resilience Task Force will look into developing more specific interventions so that we can further help and support oncology professionals during and beyond the pandemic.”

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The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.