Delay cancer treatment or risk COVID-19? Doctors and patients weigh the risks

TORONTO — An international study into the impact of COVID-19 on cancer patients has found an alarming trend: the death rate is more than twice that of other people who contract the virus, leaving doctors searching for answers on how to continue care.

The study, which had early data described in the Lancet in late May, looked at people with both diseases in the U.S., Spain and Canada. It concluded that cancer patients were much more likely to die from COVID-19 than people without cancer who got the virus.

As elective surgeries and treatments resume, doctors and patients are wrestling with the risks of delaying treatment further, versus the risk of exposing cancer patients to COVID-19 in a hospital setting.

Amid this confusion, a new web-based app developed by researchers at the University of Michigan is hoping to help clinicians weigh those risks.

Called the OncCovid app, it uses mathematical modelling to balance numerous factors, such as the probability of becoming infected within a hospital setting and the patient’s demographics.

“Clinicians will enter the patient’s age, how many illnesses, where they live, their cancer, and their treatment plan, if they’re chemo or surgery,” Holly Hartman, creator of the app and lead researcher explained to CTV News.

With this information, the OncCovid app then produces a mortality risk assessment based on immediate and delayed treatment.

“We are inappropriately delaying some people’s cancer care and also inappropriately allowing some cancer patients to continue to receive treatment,” Dr. Daniel Spratt, a researcher on the team and radiation oncologist, told CTV News.

The question of whether to delay treatment or not is one with real life consequences.

Just as the pandemic was on the rise, Cara Heitmann was diagnosed with breast cancer. She planned to get a mastectomy, but as hospitals prepared to treat COVID-19 patients, her surgery was delayed.

“I felt like a number, not a person,” Heitmann told CTV News.

“The question in my head was, ‘Are you trading one life for another?’ and ‘Who’s making that decision?’”

By the time she underwent a mastectomy, Heitmann said, the cancer had spread to the lymph nodes. She’s considered a priority patient now, but is worried about being exposed to the virus while she undergoes chemotherapy.

A weakened immune system puts Heitmann at a greater risk of dying from COVID-19 than patients who aren’t going through cancer treatment or don’t have cancer.

“It’s definitely on my mind,” she said. “It needs to be on my mind, because if I get the virus, I’m probably going to die.”

The decision to treat cancer patients now or wait until the virus is less of a threat weighs on doctors.

Dr. Monika Krzyzanowska, a medical oncologist, told CTV News that “it’s very difficult decision that we need to make for our patients.

“And we’re really spending a lot of time thinking about this.”

Spratt said that researchers developing the OncCovid app are hoping that their tool can take some of the burden off of doctors and help make things clearer to patients.

“It’s nice to have some type of metric to explain to them why,” he explained.

The study described in the Lancet that shows the risks cancer patients are facing during the pandemic draws from a database called the COVID-19 and Cancer Consortium, which collects data from more than 100 cancer centres and other organizations.

The database is still tracking this information, meaning the picture of how COVID-19 impacts cancer patients will become clearer as time goes on.

Researchers with the University of Michigan are also planning how to improve the methodology of their app as a tool in cancer care — all in the aim of being prepared for a second wave of the virus.  

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