Since last March, we’ve had a steady flow of alarming news about COVID-19’s impact on cancer care. The steep drop in screening rates was among the biggest stories, with roughly a 95 percent decrease in both mammography and colonoscopies during those first two months of the pandemic alone.
But now, a year out, reports are starting to show that the interruption — while still significant — may not be as detrimental as experts originally feared. There are even a few silver linings.
Take a recent study from Penn Medicine that looked at treatment for breast cancer patients.
With many people staying away from the hospital because of the early unknowns around the virus, a fear that treatments for breast cancer would be delayed or missed persisted. That was a cause for concern because past studies tell us that a delay drives more deaths.
Knowing all this, many health systems and hospitals pivoted to ensure patients stayed the course through thoughtful mitigation strategies. And it worked.
“Patients with newly diagnosed early-stage breast cancer treated at our institution during the COVID-19 pandemic did not wait longer to start therapy compared to patients in previous years,” said Rachel C. Jankowitz, MD, director of the Rena Rowan Breast Center at the Abramson Cancer Center, associate professor of Hematology/Oncology at the Perelman School of Medicine, and co-senior author of a recent study in JCO Oncology Practice, along with Amy I. Laughlin, MD, a Hematology-Oncology fellow at Penn.
“We implemented a number of mitigation strategies to ensure high quality care during the initial phase of the pandemic, including increased use of pre-operative hormonal therapy in appropriately selected patients,” Jankowitz said. “This allowed patients with lower-risk cancers to delay their surgeries during the initial COVID-19 surge without compromising their outcome.”
Known as “bridge care,” hormone therapy had been deemed a safe and effective substitution when surgery is not immediately available. Cancer teams applied a similar approach to other disease types during the pandemic, including endometrial cancers, which the Penn Medicine News Blog wrote about last year. An expansion of the Penn Center for Cancer Care Innovation’s Cancer Care at Home program — which includes hormone therapy to treat some breast cancers — also helped ensure patients moved forward with treatment.
“Altogether, this was an impressive feat that kept patients on track in a timely manner, during an uncertain time when so many things could have caused this to go another way,” said Lawrence Shulman, MD, the deputy director for clinical services of the Abramson Cancer Center.
Other studies have surfaced showing similarly “better-than-expected” news from one tough year.
Though the impact won’t be fully understood for some time, cancer screening rates in the United States did rebound significantly in July to near-pre-COVID levels, as people became more comfortable seeking out care and hospitals established stronger safety protocols, according to recent study in the Journal of General Internal Medicine.
At Penn, screening rates vastly improved by late summer, as well, despite surges in COVID-19 infections in the country and region that continued through the year.
The last year also left cancer centers with some positive changes.
COVID-19 has given increased attention to waiting room times, which will likely improve systems moving forward, as well as an increased focus to cancer disparities in minority communities. Work presses on at the Abramson Cancer Center to help close the gaps by increasing clinical trial participation for underrepresented patients.
“[There’s also a] renewed interest in the concept of value in cancer care, in the idea that we really need to focus on giving treatments that make the biggest difference for the patients,” wrote the authors of an international study in ecancer looking at the desirable changes to cancer care from COVID-19. One change in the early days of the pandemic the paper calls out also occurred at Penn Medicine. “In some settings, there was a shifting of procedures to day surgeries, which maximized the use of resources and was cost saving both for the patient and the health system,” they said.
Digital communication with patients vastly improved and increased, as well, ensuring they stay connected to their health care team and receive appropriate care.
Because of the rise of telemedicine, genetic counselors reported a 20 percent increase in patients receiving genetic tests in 2020 compared to 2019 at Penn Medicine. That, coupled with the fact that policies around insurance reimbursements for telemedicine were eased during the pandemic in an effort to maintain care, meant more patients knew about their cancer risk.
“Patients love telegenetics,” said Susan Domchek, MD, executive director of the Basser Center for BRCA. “And because of the pandemic, state medical boards relaxed certain licensure requirements, allowing us in many states, where we were not already licensed, to practice medicine across state lines. That meant we were able to see family members who couldn’t or wouldn’t travel to us and do cascade testing” — which is testing individuals in families who may be at risk for a hereditary cancer. Raising awareness about a genetic driver in a family member will only increase their chances of seeking our further counseling and potentially treatment if a cancer is found.
This isn’t to say that the pandemic didn’t significantly impact cancer care at Penn and everywhere else. It did.
Looking back at the JCO Oncology Practice breast cancer study, the researchers did report a reduced number of new pre-cancerous diagnoses, almost always detected by screening, because of the drop in screening. These tumors tend to be slow growing, and modest delays in screening will probably not result in poor outcomes for patients. But that relies on patients resuming their mammography screening as promptly as possible.
This past year does, however, show us that efforts to try to minimize the consequences of a disruptive and deadly pandemic have been working — and some of them may be improvements in care delivery that are here to stay.