Almost 10,000 more people will die from breast and colorectal cancer over the next decade because of disruption in care caused by Covid-19, undoing decades of progress, according to NIH projections released Thursday.
Those estimates are conservative and account for about one-sixth of all cancer deaths. But immediate action by cancer clinicians, researchers, and the federal government could mitigate the impact of delayed diagnoses, surgeries, and research, National Cancer Institute Director Ned Sharpless wrote in the journal Science.
Sharpless called for labs, hospitals, and clinics to reopen where possible.
“There was a prudent and good reason for hospitals to change their behavior at the beginning of the pandemic,” Sharpless said in an interview Thursday. “But now we’re starting to see that if that period stretches on and on and on, that will begin to impact non-Covid diseases like cancer and cause some excess death. And the NCI’s really worried about that.”
Stay-at-home orders to slow the spread of the virus also meant a slowdown in providing non-Covid care across the board, including cancer. They also stymied the ability of researchers to conduct clinical trials that are an integral part of oncology therapies and shut down laboratories.
Sharpless asked an NCI network that uses statistical modeling to improve understanding of cancer treatments to project the effects of the pandemic on cancer mortality over the next decade. It chose breast and colorectal cancers because those are common cancers with high screening rates. The projections found an increase in deaths due to the virus would peak in the next year or two, likely sooner for colorectal than for breast cancer.
The results are plausible, Sharpless said, and he wanted to get the message out that there are innovative ways to help patients return to cancer centers safely because the longer the pandemic disrupts care, the worse things will be for patients.
NCI, which is the largest of the National Institute of Health’s 27 institutes and centers, is working with universities, cancer centers, and outside researchers to find ways to screen and treat patients while prioritizing safety. It’s also working with the Food and Drug Administration to resume clinical enrollment that has lapsed during the pandemic and is funding new studies on the link between Covid-19 and cancer.
The NCI is also part of a broader agency initiative to fund projects on the effects of Covid-19 on underserved populations, Sharpless said.
“If we act now, we can make up for lost time,” he wrote.
While each hospital will have to decide when and how it’s safe to reopen, Sharpless said these decisions are fundamentally health research questions the NCI can help answer. For example, are there services that hospitals currently offer as an inpatient service that could be administered outpatient? Or is there something innovative to be done with telehealth?
“That’s kind of a clinical trial we run all the time. Now that question becomes much more pressing,” he said. “That’s our day job and that’s really what we do.”
The silver lining is the answers to those questions will remain once the pandemic is gone, Sharpless said.
“So if there’s a great way to do care by telehealth that we used to think required a visit, we’re going to know that for the rest of time. That will have a future beneficial impact for patients in the same as we modify treatment regimens and we change how we do consent.”