Getting Candid About Lung Cancer Diagnosis in the Age of COVID-19
(BPT) - The COVID-19 pandemic has caused a significant disruption in cancer care and treatment.1 As the leading cause of cancer death in the US, the potential impact on lung cancer is especially alarming.2,3 Recent studies predict a significant increase in the number of cancer deaths over the next five years due to missed screenings, delays in diagnosis and reductions in oncology care caused by COVID-19.3,4
While part of this disruption is due to the reduction and suspension of screening programs and diagnostic services caused by the reallocation of medical staff and resources to fight the pandemic, there are also other important factors at play.1 Nationwide stay-at-home orders, job and/or insurance loss and general fear of exposure to the virus during a doctor visit have resulted in people postponing care for non-COVID-19 health concerns, or foregoing it altogether.1,6 As a result of these factors, although individuals across the US are still getting lung cancer, more people are going undiagnosed until the cancer has reached an advanced stage.5
“What we are seeing in our practice is that people are not coming in for anything unless they absolutely have to,” said Joyce Knestrick, PhD, FNP-BC, FAANP. “They don’t want to go to any screenings. They don’t want to go to any hospital settings to be exposed to COVID.”
Many medical conditions, including lung cancer, will not “wait” for the pandemic to end. Putting off diagnosis and treatment may have significant negative effects on patient outcomes.5
“In my experience, if they don’t know they have a diagnosis they are not going to seek it out unless they are really sick anyway. That’s why I am really worried about the burden on the system when people come in at different levels,” Joyce continued.
Lung Cancer: There’s No Pause Button
Cancer does not discriminate, and its consequences are not pausing even if the world is.
Despite relatively stable lung cancer diagnoses rates for 13 months prior to the pandemic,7* states with a particularly high prevalence of lung cancer where the decline is most notable and severely affected by COVID-19— New York, California, Texas, Tennessee, Pennsylvania, Illinois, Michigan and Ohio— have since seen a 30-60% reduction in such diagnoses as of May 2020.
This sharp decline does not mean fewer people are developing lung cancer. Instead, quite the opposite: more individuals are going undiagnosed and delay treatment until their cancers advance.8
While some individuals with early lung cancer can have symptoms, many do not until the disease spreads. An added challenge is some symptoms such as coughing, shortness of breath and fatigue may mimic those of COVID-19.10,11
If lung cancer symptoms are noticed sooner rather than later, or people at known risk seek medical care, it might be diagnosed and treated more effectively at an earlier stage.
“I think this is a challenging time for all of us, but we are all in this together,” said Nanette Alexander, DNP, APRN, FAANP. “We want to minimize what they need for care, and early intervention does that.”
Reassuring Patients: The Time Can STILL Be Now
It is critical for people at risk for lung cancer, or with potential symptoms, to stay connected with their health care providers and learn how to best seek care given the situation. Even in the face of a global pandemic, concerns should not be put on hold.
Hospitals and clinics are doing all they can to ensure the health and safety of patients during the pandemic. Ultimately, the risk of COVID-19 must be balanced against the risk to the patient of lung cancer progression, and in most cases, lung cancer still represents a greater risk of mortality for patients.3,12
“When your providers say it is safe to go back, go back,” Nanette concluded.
For more information on cancer and COVID-19
*Compared to the average lung cancer diagnosis rates from Jan '19 to Feb '20.
References
1. Richards M, Anderson M, Carter P, Ebert BL, Mossialos E. The impact of the COVID-19 pandemic on cancer care. Nat Cancer. 2020;1:565-567.
2. American Cancer Society. Key Statistics for Lung Cancer. Available at https://www.cancer.org/cancer/lungcancer/about/key-statistics.html. Accessed August 2020.
3. Amit M, Tam S, Bader T, Sorkin A, Benov A. Pausing cancer screening during the severe acute respiratory syndrome coronavirus 2pandemic: Should we revisit the recommendations? Eur J Cancer. 2020;134:86-89.
4. Maringe C, Spicer J, Morris M, et al. The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population-based, modelling study. Lancet Oncol. 2020;21:1023-1034.
5. Kaufman HW, Chen Z, Niles J, Fesko Y. Changes in the Number of US Patients With Newly Identified Cancer Before and During the Coronavirus Disease 2019 [COVID-19] Pandemic. JAMA Netw Open. 2020;3(8):e2017267.
6. Woolhandler S, Himmelstein DU. Intersecting U.S. Epidemics, COVID-19 and Lack of Health Insurance. Ann Intern Med. 2020;173:63-64. doi:10.7326/M20-1491
7. This is based on information licensed from IQVIA Oncology Real World Insights for the period of January 2019 to May 2020 reflecting estimates of real-world activity. All rights reserved. Study details and information maintained by AZ.
8. Sharpless, NE. COVID-19 and cancer. Science. 2020;368(6497):1290. doi:10.1126/science.abd3377.
9. American Cancer Society. Signs and Symptoms of Lung Cancer. Available at https://www.cancer.org/cancer/lung-cancer/detection-diagnosis-staging/signs-symptoms.html. Accessed August 2020.
10. Centers for Disease Control and Prevention. Older Adults. Available at https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/older-adults.html. Accessed August 2020.
11. Centers for Disease Control and Prevention. Symptoms of Coronavirus. Available at https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html. Accessed August 2020.
12. Singh AP, Berman AT, Marmarelis ME, et al. Management of Lung Cancer During the COVID-19 Pandemic. JCO Oncol Pract. https://ascopubs.org/doi/full/10.1200/OP.20.00286
US-44933 Last Updated 9/20