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Time to consider how COVID-19 has also rewritten the rules for cancer sufferers and survivors

Last year when I wrote a piece on World Cancer Day we already knew about the new SARS-CoV-2 virus in a large Chinese city, but no one could have predicted where we would have ended up a year later. While many of us are frustrated with lockdowns, lack of travel and inconvenience, it is a good time to consider how this virus has rewritten the rules for cancer sufferers and survivors as well.

While medical science has focused their efforts over the past 12 months on COVID-19 vaccines and treating more effectively those with severe disease, I cannot help but feel things have not only stalled, but taken some steps back in the expected progress and improvement of cancer care and treatment outcomes. This despite cancer being the number two cause of mortality globally.

A key "vulnerable" group

Those with cancer were quickly noted to have more severe COVID-19 disease, increased risk of hospitalization and a higher risk of dying from COVID-19. This means that cancer sufferers had to "shield", often in isolation. At a key time in their lives when support from family and friends, and physical care were so needed. Cancer patients' support, by necessity, was reduced or entirely removed depending on living circumstances. The impact cancer has on the immune system, the effect of cancer treatment and the reduced physical resilience cancer sufferers have to generally fight infections, are reasons thought to contribute to this increased vulnerability.

Some of the risk factors leading to avoidable cancers – up to 40% of all cancers – themselves also contribute to more severe outcomes of COVID-19. Smokers, at much higher risk of lung cancer, have been shown to experience more severe COVID-19. Obesity and diabetes increase not only the risk of developing many cancers, but they create an insulin resistant state which itself independently leads to worse COVID-19 outcomes as we've seen in those who have diabetes or are overweight.

What was not known is whether those in cancer remission had a higher risk. Recent data does seem to suggest, while recovered cancer sufferers are not at as high a risk as those with current cancer, their risk is still higher than someone who has never been diagnosed with cancer. An unfortunate and additional burden of worry for those in remission holding out hope that their treated cancer will not come back.

Treatment and screening delays

Many health systems around the world strain under the burden of looking after COVID-19 patients, and this, in addition to delaying many routine care medical follow ups in order to reduce spread of COVID-19 infection and free up resources, has led to reduced primary cancer care. What will this delay in treatment regimes and follow-ups mean to these cancer sufferers? While some studies have tried to quantify this, and there are calculators available online to estimate changed survival if treatment is delayed, the worry due to this "sidelining" of cancer care must be quite overwhelming for an individual with cancer or suspected cancer and their families. Not only do they need to isolate and have less personal support, but the worry of what a diagnosis will be or what treatment will be recommended or how successful recent treatment has been is a load hard to imagine.

Cancer screening programs have similarly been put on hold or de-prioritized, and many affected individuals may be those at higher risk, with a strong family history or with previous screening abnormalities that require follow-up screening. This is in addition to the age and risk driven recommended screening done for key cancers like cervical, colon and lung cancer. How these delays will play out and whether a slight stage shift to the right will occur is yet to be determined.

Further screening hope

While we need to do much to improve the outcome of cancer prevention and treatment, especially during these times of COVID-19, there are glimmers of hope. A good example of this continues to be various companies driving technology for earlier cancer detection, and a recent collaboration between a leading developer of a potential breakthrough liquid biopsy test and the UK's National Health System highlights the potential that exists in this space. We will be watching this study closely.

We also need to continue to focus on risk factors, and particularly how lifestyle can increase our risk of developing cancer. While being overweight clearly increases the risk of developing cancer, our research on the big 6 lifestyle factors confirm how lifestyle can influence one's risk of developing cancer - lack of physical activity, poor nutrition, poor sleep, substances like smoking and alcohol, and harmful environmental exposures are all things we can change to impact our risk of developing cancer. Improved mental wellbeing, a growing priority, especially during these stressful and isolated times, can also benefit us as chronic stress and anxiety have been shown in some studies to increase the risk for developing cancer.

Care for cancer

While the hope for a world where COVID-19 is something of the past, or at least controlled, is something we are all looking forward to, those with cancer, in remission from cancer, or concerned about screening delays, will have a far greater reason to celebrate if we can get to that state. We need to support them in any way we can. Combined with the mental health burden we all have during these extraordinary times, those with cancer deserve additional support. Reach out to those you may know, talk openly about their concerns, and help make the world more resilient.

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