Delayed Cancer Care in Italy

"Time is often the primary variable influencing the prognosis of many cancers, so the increased cancer mortality rate must be included among the indirect effects of COVID-19."

Published  1 June 2021

The COVID-19 pandemic created the most significant, sudden change of daily life for people worldwide, especially during the first wave. Many countries instituted lockdowns, and all adopted strict social containment measures. The intensity and duration of the policies varied between countries, but their impact on the activities of the global population has been intense.

Closures of schools and other spaces dedicated to learning have affected the educational progress of the world’s student population. Physical activity decreased worldwide during the COVID-19 pandemic, raising health concerns. In countries and regions where transmission and severity of the infection were greater (e.g., the Lombardy Region in Italy)1, hospital care systems reorganised to cope with overwhelmed ICUs and high mortality rates related to COVID-19. In this dramatic context, the rate of hospital admissions for other needs, as well as those pertaining to preventive and treatment services, decreased. In many cases, non-COVID admissions were suspended for months. Patient reluctance to seek medical care in a time of uncertainty and fear of contracting COVID-19 also reduced access to hospitals and outpatient clinics.

Worryingly, authors documented that restrictive measures also compromised cancer care for many types of cancer around the world. A vast number of missed diagnoses and delayed treatments were reported. We do not yet know the effects of these delays on the extent and severity of disease. We do know, however, that waiting lists for screening and surgery have not only grown but have persisted even after a year.2 Time is often the primary variable influencing the prognosis of many cancers, so the increased cancer mortality rate must be included among the indirect effects of COVID-19.

What the long-term effects of pandemic lifestyle changes will be and the change in cancer incidence in the coming years are two of the issues that must be studied. Evidence is accumulating, and we are beginning to realise that the effects of COVID-19 are more severe and that mortality is significantly higher in cancer patients than in non-cancer patients.3 Moreover, COVID-19 engages clinical markers for the management of cancer care,4  so it also directly affects cancer diagnosis and therapy. Despite the limitations of the review – (including the reviewed studies’ limitations and the unprecedented large volume of scientific research on the subject of COVID-195 (most notably preprints, which are shorter and published faster)6 which are only partially justified by the emergence of knowledge) the results highlight the need for future research, and not only in the realm of oncology.

As the appropriate management of cancer treatment teaches, only prevention will be able to counteract the devastating effects of another pandemic on cancer care. Unfortunately, even if the WHO recommends that all Member States revise their national pandemic plans to prepare for future pandemics, the COVID-19 pandemic painfully confirmed that the world is gravely underprepared for large outbreaks of emerging infectious diseases.8 This is an error that has widely – and negatively – affected cancer care management and the rights of millions of people in the world.

Maurizio Bonati is Head of Laboratory for Mother and Child Health and of the Department of Public Health at the Mario Negri Research Institute in Milan, Italy; Titular Professor in Child Psychiatry at the University of Milan; and Editor of Ricerca & Pratica

References

1.         Jefferson T, Bonati M, Heneghan C. COVID-19 – Is Lombardy the Widow of Hampstead? The Centre for Evidence-Based Medicine, April 18, 2020.  https://www.cebm.net/COVID-19/COVID-19-is-lombardy-the-widow-of-hampstead/

2.         The Lancet Oncology. COVID-19 and cancer: 1 year on. Lancet Oncol 2021;22(4):411. doi: 10.1016/S1470-2045(21)00148-0.

3.         Erdal GS, Polat O, Erdem GU, Korkusuz R, Hindilerden F, Yilmaz M, Yasar KK, Isiksacan N, Tural D. The mortality rate of COVID-19 was high in cancer patients: a retrospective single-center study. Int J Clin Oncol 2021;26(5):826-834. doi: 10.1007/s10147-021-01863-6.

4.         Souchelnytskyi S, Nera A, Souchelnytskyi N. COVID-19 engages clinical markers for the management of cancer and cancer-relevant regulators of cell proliferation, death, migration, and immune response. Sci Rep 2021;11(1):5228. doi: 10.1038/s41598-021-84780-y.

5.         Ioannidis JPA, Salholz-Hillel M, Boyack KW, Baas J. The rapid, massive growth of COVID-19 authors in the scientific literature. bioRxiv 2020.12.15.422900; doi.org/10.1101/2020.12.15.422900.

6.         Fraser N, Brierley L, Dey G, Polka JK, Pálfy M, Nanni F, Coates JA. The evolving role of preprints in the dissemination of COVID-19 research and their impact on the science communication landscape. PLoS Biol 2021;19(4):e3000959. doi: 10.1371/journal.pbio.3000959.

7.         Ribas A, Sengupta R, Locke T, Zaidi SK, Campbell KM, Carethers JM, Jaffee EM, Wherry EJ, Soria JC, D’Souza G; AACR COVID-19 and Cancer Task Force. Priority COVID-19 Vaccination for Patients with Cancer while Vaccine Supply Is Limited. Cancer Discov 2021;11(2):233-236. doi: 10.1158/2159-8290.CD-20-1817.

8.         European Commission. Improving pandemic preparedness and management. Independent expert report November 2020. https://op.europa.eu/it/publication-detail/-/publication/a1016d77-2562-11eb-9d7e-01aa75ed71a1/language-en/format-PDF/source-171481573.

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