Liz Satterfield has a ritual for every time she returns home after leaving the house. Diagnosed with metastatic breast cancer in 2016, the Kirkland, Washington resident recently learned that the cancer that had spread to her brain in 2018 was still growing. Throughout the pandemic, she\u2019s had to visit the hospital at least once every three weeks, often more frequently, for treatments to control her disease.<\/p>\n
\u201cI have a pair of shoes in a paper bag that I keep in the trunk of my car or a rack in the garage. I only wear those shoes when I\u2019m going in to get treatment,\u201d she says. \u201cWhen I come home, I strip in the garage and put everything right in the wash. I don\u2019t enter the house with anything that I was wearing at the cancer center. It\u2019s the way I\u2019m able to control what I can control in this situation, and gave my partner and me some peace of mind.\u201d<\/p>\n
While COVID-19 has upended everyone\u2019s life, the novel coronavirus\u2019 impact on cancer patients is especially disruptive. Any infectious disease that taxes the immune system is high on their must-avoid list\u2014especially for those getting chemotherapy or radiation treatments, both of which can weaken natural defenses. So that leaves cancer patients caught in the middle of two terrifying diseases.<\/p>\n
Satterfield, left, with wife Heather Dooley and daughter Rowan on June 23, 2020<\/p>\n
Nearly 17 million people in the U.S. are living with cancer, many of whom, like Satterfield, are currently being treated for their disease, and forced to make these difficult calculations weighing their risk of cancer against their risk of getting COVID-19. Studies of cancer patients who become infected suggest that their death rate is higher\u2014ranging from 13% to 28%\u2014than those without cancer (though these numbers continue to change as more data become available).<\/p>\n
Learn the latest research-backed insights with TIME\u2019s guide to preventing cancer.<\/p>\n
That risk could have a lasting impact on cancer rates and deaths in coming years. Between existing cancer patients who are concerned about the risk of COVID-19 and either delay or skip treatments, and those who have not yet been diagnosed but are reluctant to see their doctor for possible cancer symptoms, experts say both death rates and new cases may creep up. \u201cThere have been people who are scared to death to even come near the cancer center,\u201d says Dr. Leslie Busby, a partner at Rocky Mountain Cancer Centers.<\/p>\n
A crude forecast of how the pandemic might affect deaths from just breast and colon cancers alone conducted by researchers at the National Cancer Institute (NCI) predicts 10,000 additional deaths from these two cancers on top of an expected 1 million over the next decade, based on the assumption that screenings are stopped for only six months. That model does not account for people who have not yet been diagnosed and are delaying seeing their doctors\u2014and as a result, may not be diagnosed until their cancers are more advanced and harder to treat. \u201cWe don\u2019t know what the level of disruption to care is going to be, but I think it has already been quite significant, and will last a while longer,\u201d says Dr. Ned Sharpless, director of the NCI, who commissioned the prediction.<\/p>\n
He notes that increases in incidence and deaths from cancer due to COVID-19 may also be hidden, complicated by the fact that incidence, for example, may even dip for a while if fewer people are getting screening and fewer cancers are actually detected. Mortality may also be confounded by the fact that most cancer deaths are among older patients, and older patients are also at higher risk of dying from COVID-19 complications, so the pandemic could cause total cancer deaths to actually decrease tempoerarily.<\/p>\n
Given those confounders, and the fact that many cancers take years to develop, it won\u2019t be clear exactly how COVID-19 has affected cancer rates and deaths for many years yet.<\/p>\n
\u201cWhen you think of cancer care, there is very little that is elective,\u201d says Dr. Robert Keenan, chief medical officer and vice president of quality at Moffitt Cancer Center in Tampa, Fl. Patients get chemotherapy as an intravenous infusion, which needs to be dosed and administered under medical care, and radiation treatments require calibrated doses from certified technicians in hospitals. And once patients have started chemotherapy or radiation regimens, they usually undergo treatment for several weeks, with each cycle building on the last to give them the best chance of wearing the cancer down and stopping malignant cells from growing and spreading.<\/p>\n
As the pandemic began to surge, cancer doctors typically evaluated each of their patients to decide whether they needed to come in for their treatments or whether they could safely put off the chemotherapy infusion or radiation session for a week or more. Nancy Fleming, a former hospital pharmacist who was diagnosed with small cell lung cancer in 2019 after surviving breast cancer in 2003, receives an infusion of an immunotherapy drug once a month at the Dana Farber Cancer Institute in Boston, Mass. When cases of COVID-19 surged in Boston in April, her oncologist, Dr. Jacob Sands, suggested she put off one of her infusions by a week. He says he made these types of decisions on a case-by-case basis, depending on how well each individual patient was doing and how well-controlled their cancer was. \u201cFor somebody who has ongoing disease control, where everything is stable, and they had been on therapy for more than a year, those were cases where we would discuss delaying treatment by a week, two weeks or even three weeks,\u201d Sands says.<\/p>\n
Convincing them to continue their treatments wasn\u2019t easy, however. \u201cThere was a lot of virtual and telephonic hand-holding,\u201d says Keenan. \u201cWe tried to put in place measures to create an environment that let patients know that [the cancer center] was as safe a place as any to come in for their treatment.\u201d At many hospitals and cancer centers, patients and staff have been screening patients and staff for fever and COVID-19 symptoms, and many restricted visitors from coming with the patients for their treatments. Any care that could be provided virtually was moved to video or telemedicine, which cut down on the density of people. At Moffitt, Keenan says, clinic visits dropped by 40% to 50%, and patient appointments were scheduled to avoid pile ups waiting rooms. At Dana Farber, Sands says \u201cPatients were essentially able to get right into a private room when they showed up and we were able to completely isolate people so they were not sitting next to each other in the waiting room.\u201d<\/p>\n
Such cues are critical to putting cancer patients\u2019 at ease, agrees Busby, who asked non-essential staff to work from home. \u201cThese practices helped to both lower the risk of spreading COVID-19 and sent signals to our patients that we were doing the best we can to protect their health,\u201d he says. Discussing these precautions helped to convince some wary patients to continue their treatments.<\/p>\n
One such policy, however, was harder for patients to accept. Many cancer centers stopped allowing visitors to come with patients during their treatment appointments, which can stretch for several hours since the chemotherapy infusions themselves typically take at least 30 minutes. \u201cIt\u2019s such a comfort to have family there,\u201d says Fleming. \u201cWhen you are a patient, when you are ill, it\u2019s sometimes hard for you to absorb everything you are hearing. It\u2019s always good to have an advocate with you.\u201d<\/p>\n