Impact of COVID-19 Infection on Cancer Care Delivery
Early reports from China observed that patients with cancer harbored a higher risk of infection compared with the overall population16 and that oncologic patients have an elevated risk of admission to the intensive care unit, invasive ventilation, and death.17 Nonetheless, these remain preliminary reports with small, heterogeneous samples. While data on immunosuppressed patients remain limited, the potential threat for immunocompromised cancer survivors is not to be ignored. Head and neck cancer (HNC) survivors, who already incur some of the highest cancer-related treatment costs18, may represent a population particularly vulnerable to viral transmission. On account of the diseases they treat, otolaryngologists and, by extension, their patients are at a higher risk of contracting the virus.19 To this effect, otolaryngology clinics and departments around the world have altered their regular workflow and practice.20,21 The American Academy of Otolaryngology – Head and Neck Surgery (AAOHNS) and the American Head and Neck Society (AHNS), among others, have put forth recommendations that include limiting elective procedures, transferring non-urgent visits to remote care via telemedicine, and implementing strict aerosol precautions and appropriate personal protective equipment (PPE) donning for emergent procedures.22-24 For patients with malignancies, oncology providers must weigh the risks of viral exposure with that of treatment delay and potentially disease progression, both of which, if not well-balanced, may lead to exacerbated financial toxicity and poorer health outcomes. Interventions to emulate may be modeled after centers which have faced similar situations during previous coronavirus epidemics including 1) developing a multi-pronged approach; 2) focusing on a crisis management plan; and 3) transparency in leadership and communication regarding specific recommendations for both inpatient and outpatient oncologic patients, staff management, infection control, and recovery after control of the outbreak.25
It is imperative to note, however, that this does not make a case against physical distancing as models show that short-term business closures are necessary to mitigate a potentially worse long-term economic collapse that may result from additional lives lost without strong containment measures.26 The pandemic is predicted to have significant impacts on the economy beyond the immediate effects of public health measures. A recent article analyzing historic data from the 1918 influenza pandemic in the United States concluded that the pandemic lead to a sharp and persistent decline in economic activity, reducing manufacturing output by 18%.27 Reports studying prior economic recessions have also found a link between such economic decline and mortality.28,29 Research by health economists has identified heterogeneity in the effect of recessions on mortality. While the relationship between macroeconomic environments and health behaviors has remained generally stable, cancer mortality has become more sensitive to financial strain and limited access to health resources when compared to other diseases.30 This phenomenon is postulated to result from advances in expensive cancer treatments and technologies, which places cancer survivors at a particular disadvantage during difficult economic climates.