Slideshow: COVID-19 Pandemic Affects the Cancer Continuum
February 11, 2022ACS studies show how COVID-19 is affecting prevention efforts, cancer screening rates, treatment, quality-of-life, and research.
COVID-19 took over the world in 2020 but getting reliable data to understand its effect on cancer takes time—usually 2 to 3 years using traditional population-based data sources like state cancer registries.
Until data started becoming available, researchers had to find innovative ways to gather some facts.
These slides are a sample of American Cancer Society (ACS) studies published in 2021 based on data found in both traditional and less familiar ways. They show the beginnings of how the COVID-19 pandemic is affecting the continuum of cancer care.
Select any photo below to start the slideshow.
<p><b>In less than 2 months </b>after the United States identified its first cases of COVID-19, there were <b>more than 100,000 cases </b>and <b>2,000 deaths.</b></p>
<p> </p>
<p>Everyone attempted to prevent the virus from spreading:</p>
<ul>
<li>Most states went into <b>lockdown</b>.</li>
<li>Local governments advised people to <b>stay home</b> and away from work, school, restaurants, gyms, family—even doctors’ offices and hospitals.</li>
<li>Many doctors’ offices and hospitals completely <b>shut down non-urgent services and elective procedures, and delayed</b> visits for prevention, screening, treatment, and follow-up care. </li>
</ul>
<p><b>Disruptions in health care have affected the full range of cancer care</b> and care for others who may have a higher risk for being hospitalized and dying from coronavirus infection. The pandemic has also increased the risk for people with cancer or with a history of it to have a<b> reduced quality of life</b> due to cancer worry, health anxiety, depression, and inactivity.</p>
<p><b>Delay in cancer diagnosis and surgery has been linked with worse health outcomes</b>.</p>
<p> </p>
<p>To learn how the pandemic was affecting the number of people being checked or treated for cancer, an ACS research team <b>compared the number of real-time electronic pathology reports in 2020 and 2019</b>. They found <b>a 10% decline</b> in 2020 after the pandemic had started.</p>
<p> </p>
<p><i>“We found declines in records across all cancer sites and ages. That suggests that there were <b>delays in the start of treatment,</b> as well as in evaluation of signs and symptoms, cancer screening, and routine well-child and primary care visits.”</i></p>
<p style="text-align: right;">— <a href="/content/cancer/en/research/acs-researchers/robin-yabroff.html" target="_blank">Robin Yabroff, PhD, MBA</a>, lead study author and <br>
ACS Senior Scientific Director, Surveillance Research</p>
<p> </p>
<p><a href="https://academic.oup.com/jnci/advance-article/doi/10.1093/jnci/djab122/6307727?searchresult=1" target="_blank">See the study. </a><br>
</p>
<p>In most states, the COVID-19 pandemic hasn't helped increase the low lung-cancer screening rates of people eligible for a yearly low-dose computed tomography (LDCT).</p>
<p> </p>
<p>Surprisingly, though, when ACS researchers<a> </a><span style="background-color: transparent;">compared screening rates between 2019 and 2020, they found </span><b style="background-color: transparent;">19 states had improved screening rates</b><span style="background-color: transparent;">—with Kentucky having the most improvement.</span><br />
</p>
<p> </p>
<p><i style="background-color: transparent;">"Kentucky's screening implementation efforts led to rates<b> more than 2 times the national average </b>and <b>4 times that of West Virginia and Arkansas, </b>other high lung-cancer burden states.”</i></p>
<p style="text-align: right;">—Robert Smith, PhD, study co-author and <br />
ACS Senior Vice President, Cancer Screening</p>
<p> </p>
<p>See<b> </b><a href="/content/cancer/en/research/acs-research-highlights/lung-cancer-research-highlights/work-must-persist-to-further-lung-cancer-screening-and-equity.html" target="_blank">“Work Must Persist to Further Lung Cancer Screening and Equity.”</a></p>
<p>During the early months of the COVID-19 pandemic, screenings for cancer in the breast, colon and rectum, cervix, and lung have decreased by as much as 90% in the worst periods. <b>Delays have been highest within low-income and rural communities, and for people of color.</b></p>
<p> </p>
<p>With moneys raised through the <b>Crucial Catch: Intercept Cancer campaign,</b> the <b>ACS and the National Football League (NFL)</b> allocated resources to help <b>safely restart cancer screenings</b> in communities with the most need.</p>
<p> </p>
<p>Those funds make possible the ACS Community Health Advocates Implementation Nationwide Grants for Empowerment and Equity (CHANGE) grants.</p>
<p> </p>
<p><i>“ACS CHANGE grants are helping health centers create and adopt new processes and protocols to <b>tackle cancer screening backlogs and safely restart cancer screening."</b></i></p>
<p style="text-align: right;">—Korey Hofmann, MPH, ACS Cancer Control<br>
Strategic Partnerships Manager</p>
<p> </p>
<p>Learn more about <a href="/content/cancer/en/about-us/our-partners/nfl.html" target="_blank">Crucial Catch</a>.</p>
<p>Between July 2018 and 2019 <b>BEFORE the pandemic,</b> breast cancer screening rates <b>improved by 18%</b> within 32 community clinics, which largely serve people with low incomes.</p>
<p> </p>
<p>But between July 2019 and July 2020, <b>DURING the</b> <b>pandemic,</b> an ACS study showed that breast cancer screening <b>dropped steeply—by 8%</b> in those clinics.</p>
<p> </p>
<p>Findings show that if these trends continue, there would be <b>potentially 47,517 FEWER mammograms and 242 missed breast cancer diagnoses </b>in this population.</p>
<p><i> </i></p>
<p><i>"People with lower incomes have long-standing barriers to accessing care and are especially vulnerable to healthcare disruptions.”</i></p>
<p style="text-align: right;">— Laura Makaroff, DO, senior study author and<br />
ACS Senior Vice President, Prevention & Early Detection</p>
<p> </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/34436765/" target="_blank">See the study</a>, funded via a 2018 ACS CHANGE grant supported by the ACS & National Football League's <a href="/content/cancer/en/about-us/our-partners/nfl.html" target="_blank">Crucial Catch: Intercepting Cancer campaign.</a></p>
<p>To help reduce the backlog of cancer screening services due to COVID-19, the ACS led an intervention and study with 22 federally qualified health centers (FQHCs) across 15 US states. <span style="background-color: transparent;">These centers provide critical cancer prevention services and treatment to under-resourced rural and urban populations, helping ease and reverse racial and ethnic disparities.</span></p>
<p><b> </b></p>
<p>A key finding was that <b>half of the FQHCs in the study were able to continue colon cancer screenings by using <a href="/content/cancer/en/cancer/colon-rectal-cancer/detection-diagnosis-staging/screening-tests-used.html" target="_blank">at-home stool testing.</a></b></p>
<p> </p>
<p><i>“Supplementing existing screening models with self-collected screens may be an important tool to eliminate current screening deficits and prevent future cancers.”</i></p>
<p style="text-align: right;">—Marcie Fisher-Borne PhD, MPH, MSW, lead study author and<br>
ACS Managing Director, Interventions and Implementations</p>
<p> </p>
<p><a href="https://www.sciencedirect.com/science/article/pii/S0091743521002504">See this study,</a> funded via a 2020 ACS CHANGE grant supported by the ACS & National Football League’s <a href="/content/cancer/en/about-us/our-partners/nfl.html" target="_blank">Crucial Catch: Intercepting Cancer campaign</a>. </p>
<p>Also see: <a href="/content/cancer/en/research/acs-research-highlights/colon-and-rectal-cancer-research-highlights/research-to-improve-colorectal-cancer-screening-during-covid-19-pandemic.html" target="_blank">Research to Improve Colorectal Cancer Screening During COVID-19 Pandemic</a> about ACS grantee Jesse Nodora, DrPH</p>
<p>In the same study of 22 FQHCs, researchers mentioned a promising method that could allow cervical cancer screening to continue throughout pandemic disruptions—<b>HPV self-collection</b>. </p>
<p> </p>
<p>Home HPV tests include a long, cotton swab or brush, a tube, a biohazard bag, and shipping label for mailing to the testing company. Although they can be bought online in the US, they are <b>not approved by the Food and Drug Administration (FDA</b>). Ongoing studies are checking to see if home sampling and mailing leads to accurate results.</p>
<p> </p>
<p><i>“HPV self-collection of cells is <b>currently being done in Australian and the United Kingdom </b>for under-screened populations. Studies show that cells collected at home have a similar detection rate of precancer and cancer as those collected in an office by a health care professional.”</i><br>
</p>
<p style="text-align: right;">—Marcie Fisher-Borne PhD, MPH, MSW, lead study author,<br>
ACS Managing Director, Interventions and Implementations</p>
<p> </p>
<p><a href="https://www.sciencedirect.com/science/article/pii/S0091743521002504">See this study,</a> funded via a 2020 ACS CHANGE grant supported by the ACS & National Football League’s <a href="/content/cancer/en/about-us/our-partners/nfl.html" target="_blank">Crucial Catch: Intercepting Cancer campaign</a>. </p>
<p>People with these health conditions have a higher risk of developing severe COVID-19 illness: cancer, chronic obstructive pulmonary disease (COPD), diabetes, heart disease, and obesity.</p>
<p> </p>
<p>Unfortunately, cancer survivors are more likely to also have one or more of these other conditions compared to those who haven’t had cancer, which increases their risks of serious COVID-19 even more.</p>
<p> </p>
<p><b>A study of cancer survivors</b> led by an ACS researcher found that:</p>
<ul>
<li><b>56% had at least 1 other high-risk condition</b>, including nearly half of even the youngest group, ages 18 to 44.</li>
<li><b>31% had obesity,</b> heart diseases (25%), diabetes (17%), and COPD (9%).</li>
<li><b>Survivors of cancer in the kidney, liver, or uterus </b>were the most likely to have another high-risk condition.<b></b></li>
</ul>
<p><i>“The findings highlight the need to protect cancer survivors against COVID-19 transmission and to prioritize survivors in vaccine allocation.”</i></p>
<p style="text-align: right;">—<a href="/content/cancer/en/research/acs-researchers/xuesong-han-bio.html" target="_blank">Xuesong Han, PhD</a>, senior study author and<br>
ACS Scientific Director, Health Services Research</p>
<p><a href="https://bit.ly/3oJOrwi" target="_blank">See the study</a>.</p>
<p>Within 30 days after developing COVID-19, a study revealed that 13% to 33% of people with cancer die, compared with 0.5% to 2% in the general population. </p>
<p> </p>
<p>To understand why, a clinical trial studied nearly 5,000 people who had a history of both cancer and COVID-19.</p>
<p> </p>
<p>Researchers discovered that the <b>risk for severe COVID-19 as well as the risk of dying within 30 days after a COVID-19 diagnosis was higher in people with cancer,</b> who:</p>
<ul>
<li>Are not able to take care of themselves</li>
<li>Have an active and progressing cancer</li>
<li>Are older than age 40</li>
<li>Recently received chemotherapy </li>
<li>Are male</li>
<li>Have a blood cancer</li>
<li>Are Black </li>
<li>Also have a lung condition, kidney disease, or diabetes</li>
</ul>
<p><i>“We were <b>particularly concerned </b>to find a <b>more than 40% <a href="/content/cancer/en/latest-news/understanding-cancer-death-rates.html" target="_blank">death rate</a> from COVID-19 among people receiving the chemotherapy R-CHOP </b>with the intent to cure non-Hodgkin lymphoma.”</i></p>
<p style="text-align: right;"><span style="background-color: transparent;">– <a href="https://podcasts.apple.com/us/podcast/covid-19-cancer-consortium-collaborative-effort-to/id1454395139?i=1000479125978" target="_blank">Dimpy Shah, MD, PhD,</a> study author and ACS grantee from <br>
Long School of Medicine - UT Health San Antonio</span></p>
<p><a href="https://www.annalsofoncology.org/article/S0923-7534(21)00874-7/fulltext" target="_blank">See study.</a></p>
<p>In the same clinical trial of nearly 5,000 people with a history of cancer and COVID-19, researchers found that people receiving certain types of cancer treatment <b>may have less risk of developing severe COVID-19 than the general population.</b></p>
<p> </p>
<p><b>Treatments NOT associated with higher COVID-19 severity included:</b></p>
<ul>
<li>Certain combination immunotherapies given to people with multiple myeloma</li>
<li><b>Immunotherapy </b>in general</li>
<li><b>Targeted therapies</b> in general</li>
<li><b>Endocrine therapies</b> in general (In another study, researchers found that people who had received endocrine therapy had the strongest protection from COVID-19 after receiving 2 vaccinations.)</li>
</ul>
<p><i>“This finding is encouraging because more than 40% of people with advanced cancer may be eligible for immunotherapy.”</i></p>
<p style="text-align: right;">– <a href="https://podcasts.apple.com/us/podcast/covid-19-cancer-consortium-collaborative-effort-to/id1454395139?i=1000479125978" target="_blank">Dimpy Shah, MD, PhD,</a> study author and ACS grantee<br>
from Long School of Medicine - UT Health San Antonio</p>
<p> </p>
<p><a href="https://www.annalsofoncology.org/article/S0923-7534(21)00874-7/fulltext" target="_blank">See study.</a> </p>
<p>COVID-19 vaccines are highly effective in the general population, but what about in people with cancer?</p>
<p> </p>
<p>An international study investigated how protected people with a blood cancer or solid tumor were after receiving a first and second dose of Moderna or Pfizer vaccines. <span style="background-color: transparent;">They found:</span></p>
<ul>
<li>A<b> second dose was needed to boost antibody levels</b> in people with either a blood cancer or solid tumor and protection was highest 3 to 4 weeks after that dose.</li>
<li><b>No difference between the 2 vaccine</b> brands’ effectiveness.</li>
<li>People with <b>blood cancers were not as protected</b> from COVID-19 vaccination as those with solid tumors were.</li>
</ul>
<p><b style="background-color: transparent;"><i>“After 2 vaccines, 98% of those with a solid tumor had antibodies against the virus, compared to 77% of those with blood cancers.”</i></b><br />
</p>
<p style="text-align: right;">– <a href="https://podcasts.apple.com/us/podcast/covid-19-cancer-consortium-collaborative-effort-to/id1454395139?i=1000479125978" target="_blank">Dimpy Shah, MD, PhD,</a> lead study author and ACS research grantee<br />
from Long School of Medicine-UT Health San Antonio</p>
<p><a href="https://www.cell.com/cancer-cell/fulltext/S1535-6108(21)00330-5" target="_blank">See study.</a><br />
</p>
<p>The same vaccine study of 131 cancer patients found that even after receiving both vaccine doses, the 7 people taking rituximab (Rituxan) in the study were not protected.</p>
<p> </p>
<p><b>Rituximab is one component in R-CHOP therapy, </b>an IV treatment for people with<b> non-Hodgkin lymphoma</b>. It’s also used to <b>treat chronic lymphocytic leukemia (CLL) as well as for people with rheumatoid arthritis.</b></p>
<p> </p>
<p><i>“The optimal approach for vaccinating and monitoring this subset of patients at high risk for not responding to COVID-19 vaccines remains unclear. <b>Our results stress the importance of identifying these patients at high risk so alternate protection strategy can be developed.”</b></i></p>
<p style="text-align: right;">– <a href="https://podcasts.apple.com/us/podcast/covid-19-cancer-consortium-collaborative-effort-to/id1454395139?i=1000479125978" target="_blank">Dimpy Shah, MD, PhD,</a> study author and ACS grantee<br>
from Long School of Medicine - UT Health San Antonio</p>
<p> </p>
<p><a href="https://www.cell.com/cancer-cell/fulltext/S1535-6108(21)00330-5" target="_blank">See study.</a></p>
<p>People with blood cancer are more vulnerable to COVID and less protected by vaccines. But help may come from those who have recovered from a COVID-19.</p>
<p> </p>
<p>A retrospective study found that <b>convalescent plasma seemed to reduce the 30-day <a href="/content/cancer/en/latest-news/understanding-cancer-death-rates.html" target="_blank">death rate</a></b> in adults hospitalized with a blood cancer and COVID-19.</p>
<p> </p>
<p>Convalescent plasma, also known as “survivor’s plasma,” <b>contains high levels of COVID-19 antibodies</b>, which help fight the virus. <b>This plasma is the liquid part of blood donated from people who have recovered from COVID-19.</b> </p>
<p> </p>
<p>Doctors treating people with blood cancers hospitalized for COVID-19 may prescribe convalescent plasma early in the course of the infection.</p>
<p> </p>
<p><i>“If our finding holds up in clinical trials, convalescent plasma would be, to our knowledge, <b>the first COVID-19 intervention with a survival benefit in this high-risk population.”</b></i></p>
<p style="text-align: right;">– <a href="https://podcasts.apple.com/us/podcast/covid-19-cancer-consortium-collaborative-effort-to/id1454395139?i=1000479125978" target="_blank">Dimpy Shah, MD, PhD,</a> co-leader study author and ACS grantee from<br>
Long School of Medicine - UT Health San Antonio</p>
<p><a href="https://www.medrxiv.org/content/10.1101/2021.02.05.21250953v1" target="_blank">See study</a>.</p>
<p>In June 2020, ACS researchers sent a subset of <a href="/content/cancer/en/research/cps3-cancer-prevention-study-3/covid-19-symptom-tracker.html" target="_blank">CPS-3 participants</a> (more than 2,400) a COVID-19 survey. Their goal was to see how the pandemic was affecting mental health.</p>
<p> </p>
<p>Participants’ responses suggest that:</p>
<ul>
<li><b>42% had <a href="/content/cancer/en/treatment/treatments-and-side-effects/physical-side-effects/emotional-mood-changes.html" target="_blank">mild distress</a>.</b></li>
<li><b>10% had moderate-to-severe anxiety or depression</b>, especially when they had a <b>health condition, such as cancer, </b>that increased their risk for severe COVID-19.</li>
<li><b>Females were more likely to have higher distress,</b> especially anxiety.</li>
<li><b>Men were 11 times more likely to be depressed</b> if they were distressed before the pandemic.</li>
</ul>
<p> </p>
<p><i>“These responses highlight public health priority to identify adaptable strategies for improving mental health during the pandemic.”</i></p>
<p style="text-align: right;"> – <a href="/content/cancer/en/research/acs-researchers/corinne-leach-bio.html" target="_blank">Corinne Leach, PhD, MPH, MS</a>, lead study author and<br>
ACS Senior Principal Scientist, Behavioral Research</p>
<p><a href="https://www.sciencedirect.com/science/article/pii/S2667193X2100065X?via%3Dihub" target="_blank">See study</a>. </p>
<p>One benefit of the ACS study led that used the ACS CAN Survivor Views Panel Study was that it captured participants own words about their <b>worries about treatment and finances early in the US COVID-19 pandemic. </b></p>
<p> </p>
<ul>
<li>"My surgery is <b><i>reconstruction</i></b><i>. It’s considered non-essential, but it is essential to me.”</i></li>
</ul>
<p style="text-align: right;">—50-year-old breast cancer survivor</p>
<p style="text-align: right;"> </p>
<ul>
<li><i>“I have my every-6-month <b>PET scan</b> coming up. . . to make sure I’m still in remission, and I’m very nervous that they will cancel. . . . These scans are the ones I’m scared about but also want done to know how I’m doing.”</i></li>
</ul>
<p style="text-align: right;">–27-year-old female melanoma survivor</p>
<p style="text-align: right;"> </p>
<ul>
<li><i>The <b>pain</b> is excruciating, and I have to make a choice between pain medication or anti-anxiety medicine since I am not permitted to have both at the same time.”</i></li>
</ul>
<p style="text-align: right;">—54-year-old ovarian cancer survivor</p>
<p style="text-align: right;"> </p>
<p>All responders were treated for cancer in the last 5 years and were either ACS volunteers, event participants, or information requestors.</p>
<p><a href="https://bit.ly/2OYE77k" target="_blank">See the study.</a> Listen to podcast about <a href="https://soundcloud.com/user-378624011/the-rise-of-mental-health-distress-during-the-covid-19-pandemic" target="_blank">Mental Health During COVID-19 Pandemic</a></p>
<p>Using results from surveys before and after the start of the pandemic, ACS researchers studied the amount of time people spent doing light and moderate-to-vigorous activity, being sedentary, and sleeping each day.</p>
<p> </p>
<p>They found that during the pandemic, participants spent:</p>
<p> </p>
<ul>
<li><b>Almost 2 MORE hours a day (1 hour and 44 min) being sedentary</b>—sitting or reclining while awake, such as while watching tv, working at a computer, driving, and eating. <b>Before the pandemic, they spent this time doing light or moderate activity.</b></li>
<li><b>Hours spent sleeping did not change overall.</b> However, those <b>who were laid off</b> <b>slept 68 minutes more</b> a day.<b></b></li>
</ul>
<p> </p>
<p><b>“</b><i>Our findings can help inform public health messages and interventions to end these patterns. The need is urgent because<b> the balance of daily physical activity, sedentary time, and sleep are widely recognized as key risk factors for heart disease, cancer, and premature death.”</b></i></p>
<p style="text-align: right;">—<a href="/content/cancer/en/research/acs-researchers/erika-rees-punia-bio.html" target="_blank">Erika Rees-Punia, PhD, MPH,</a> lead study author</p>
<p> </p>
<p><a href="https://doi.org/10.1016/j.mhpa.2021.100425" target="_blank">See study.</a></p>
<p>One well-established strategy to ease symptoms of anxiety and depression is being physical active.</p>
<p> </p>
<p>To examine the potential impact of the COVID-19 pandemic on the relationship between exercise and mental health, ACS researchers looked at survey responses from CPS-3 participants before the pandemic from the 2018 survey and after the start of the pandemic from the COVID-19 survey. </p>
<p> </p>
<p>Researchers found that<b style="background-color: transparent;"> the risk of having depression INCREASED</b><span style="background-color: transparent;"> for those who:</span><br>
</p>
<ul>
<li><b>Stayed or became physically inactive, </b>compared to those who stayed or became<b> </b>active.<b></b></li>
<li><b>Spent more time sitting or reclining </b>(being sedentary) compared with those who were <b>just as sedentary as they were before</b> the pandemic.<b></b></li>
<li><b>Increased sedentary time AND stayed or became inactive</b> were <b>3x more likely</b> to have depression and had more than an 80% chance of anxiety symptoms.</li>
</ul>
<p> </p>
<p><i>“Finding ways to be physically active during times that feel stressful, tiring, and a little scary—like this pandemic—may be a good way to reduce the risk of depression.”</i></p>
<p style="text-align: right;">—<a href="/content/cancer/en/research/acs-researchers/erika-rees-punia-bio.html" target="_blank">Erika Rees-Punia, PhD, MPH,</a> lead study author</p>
<p><a href="https://doi.org/10.1016/j.mhpa.2021.100425" target="_blank">See study.</a></p>
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