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ESMO 2020 | The medium and long-term impacts of COVID-19 on cancer care

Guy Jerusalem, MD, PhD, University of Liège, Liège, Belgium, discusses the medium and long-term impact of COVID-19 on cancer care. In a survey, 34% of surgery, 20% of chemotherapy and 10% of radiotherapy were canceled or significantly delayed. The survey also looked into the use of telecommunications. All the patients had a level of interaction via telecommunications and 80% indented to use it to some capacity in the future. The long-term effects of the pandemic on finances may have a significant impact on cancer patients and their accessibility to healthcare. This interview was recorded via an online conference call with The Video Journal of Oncology (VJOncology).

Transcript (edited for clarity)

I have the privilege to present the data of our survey. So we were interested in what the oncology community is thinking about in medium and long-term outcome of COVID. And first question was, of course, what is about the impact to console the treatment? So our survey was constructed by 20 oncologists from 10 of the most affected countries in the world when the pandemic started...

I have the privilege to present the data of our survey. So we were interested in what the oncology community is thinking about in medium and long-term outcome of COVID. And first question was, of course, what is about the impact to console the treatment? So our survey was constructed by 20 oncologists from 10 of the most affected countries in the world when the pandemic started. We send it out the survey to 18 different countries, and we had 109 answers to our survey, and this answers was all based on invitation to our survey. So the first thing, what are the most effective treatment modalities? And we will define as an effect treatment modality, if in a particular center, at least 10% of the patients had either cancellation or major delay of this treatment modality. And to be seen the most effected for surgery with 34% of the centers that reported that surgery was affected, followed by chemotherapy over 20% of the centers, and then radiotherapy still over 10% of the centers.

Like we also learned is that in 32% of the centers, we stopped earlier, an active palliative anti-cancer therapy and most importantly, 64% of the participants are concerned about the risk of undertreatment. So this means that the patients have fear about COVID and may decline to receive an indicated AccuVent treatment of a treatment for early metastatic setting, where we invested treatment with major impact on disease. Concerning now, other aspects we looked also to the use of teleconsultation and as expected, almost all the participants used, at least in some patients, data consultation, almost everyone for long-term follow-up and for targeted oral agents. But also more than half of the participants use the consultation for patients who receive chemotherapy of immunotherapy. And over 80% indicated they expect to use more frequently, also teleconsultation in the future. We looked also to the whole of virtual meetings and almost all of us use more frequently as expected this virtual meetings, the team meetings of continued medical education.

But interestingly for 45% of us, we estimate that this is not a very good alternative to live meetings, for international meetings size as ASCO because what we like there also is not only to see the presentation, but also to have the interaction between the participants. And this is really what is lacking when you have only this virtual meetings. We looked also to the wellbeing of the participants and only 18% estimate that at the end of the year, they will not be back to the same wellbeing than before the crisis and also there is an easy access to psychological support, only a minority about 10% will use or have used psychological support. Now, looking to the future, we have two major concerns about a risk. On one hand, we have seen everywhere in the world that because of the pandemic, there are much less new cases that YAG knows, and of course cancer is not disappearing.

So this means that actually the patients don’t come to the centers and that we are not doing the diagnosis this. And with time the risks of course, that there will be a migration of the stage and we believe much more advanced disease stages. And then the second long-term impact, maybe the financial impact that this time we are not yet seeing this so much, but we expect that because of the pandemic, that there will be financial problems in the next years. And for many of our patients may be, unfortunately, this will lead to the absence of access to good healthcare. So these are really our long-term concerns from the reserve. This is what we start now to see those activities going up again. We see more for new cases and we are now a little bit afraid what could happen if there’s really a second wave, because the first time we block the whole hospital for the first wave and except in oncology, only emergency treatment were performed.

But now it will not be possible in the second time to block all the country, to block the healthcare system totally. And now we have to treat the COVID patient in addition to the other patients, but we cannot stop to treat everything else. Now the real impact we don’t know, if now the patients come back, probably a few months of delay in diagnosis would not have a huge impact, but that would be the hope is that there will not be any more important second wave. And that patients continue to stay away from the hospital, at least a significant percentage. We have a long delay in their diagnosis.

 

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