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.