COVID-19 raising cancer deaths, say WHO, specialists

• WHO decries rising cancer cases in Africa, from 338,000 in 2002 to 846,000 in 2020
• Patients with cancer face reduced access to care, competition for scarce resources
• Breast cancer costs N18m out-of-pocket for initial treatment
• About 200 Nigerians die every day from cancer, with 32 from breast cancer, 28 from cervical
cancer, 16 from prostate cancer, 14 from liver cancer

As nations mark World Cancer Day today, there are concerns that COVID-19 has further reduced the chances of survival of cancer patients.

Reports from the World Health Organisation (WHO), Union for International Cancer Control (UICC) and cancer experts indicate that COVID-19 raises death risk in cancer patients.

UICC, in a paper published, yesterday, in the medical journal, The Lancet Oncology, ahead of the World Cancer Day titled “Cancer burden, finance, and health-care systems” said less prevention, delayed treatment and suspended early detection programmes and diagnoses, caused by COVID-19, could lead to a higher number of deaths from cancer in months and years to come.

It observed that COVID-19 is placing huge pressure on health systems, and patients with cancer, who face reduced access to care and competition for finite resources.

He added that because of COVID-19, the ability of Civil Society Cancer Organisations (CSCOs) to deliver services and their future sustainability has received less attention.

“A survey published in July, 2020, showed that 140 (89 per cent) of 157 CSCOs reported an increased demand for support services at the same time as expecting an average decrease in income of 46 per cent during the next 12 months,” the report said.

There was a pointer that cancer organisations around the world are experiencing sharp decline in funding and operational resources. A pulse survey conducted by UICC with over 100 of its member organisations in 55 countries,
revealed that almost three quarters experienced reductions in income of anywhere from 25 per cent to 100 per cent. An analysis of the survey is available in The Lancet Oncology.

It noted: “Cancer patients have suppressed immune systems and so due to their fears as well as those of family members, related to COVID-19, they may cancel or delay hospital visits. A similar fear of contagion may mean that people do not seek in-person medical advice, thus delaying the start of treatment.

“Restrictions on travel and social distancing guidelines also represent barriers to seeking care. Resources (medicines, protective gear, hospital staff) have often been diverted to the coronavirus response.”

According to the World Health Organisation (WHO), there are currently 43.8 million cancer patients worldwide, with over 18 million new cancer cases yearly. Cancer is now responsible for one in six deaths globally, with 9.6 million deaths from cancer each year. Sadly, 70 per cent of cancer deaths occur in developing nations like Nigeria.

According to the National Cancer Prevention Programme (NCPP), there are currently over 200,000 cancer cases in Nigeria with over 100,000 new cases occurring every year. About 200 Nigerians die every day from cancer, with 32 of these daily cancer deaths resulting from breast cancer, 28 from cervical cancer, 16 from prostate cancer and 14 from liver cancer.

National Coordinator, NCPP, Dr. Abia Nzelu, told The Guardian: “Furthermore, WHO projects that if things remain the same, there will be a 60 per cent increase in cancer cases within two decades, with the greatest increase (over 80 per cent) occurring in developing countries, including Nigeria.”

Nzelu said this projected increase is likely to be even greater, because of the multiple negative impact of the COVID-19 pandemic on cancer care (budgetary diversion of local resources towards addressing the COVID-19 crisis; restriction on crowding, which is required for mass cancer screening; increased strain on health personnel and infrastructure; and restriction on medical tourism).

On the impact of COVID-19 on cancer research, care and treatment, a professor of radiology and head of radiation medicine department at the College of Medicine, University of Nigeria, Nsukka/University of Nigeria Teaching Hospital Enugu (UNTH), Enugu State, Ifeoma Okoye, told The Guardian: “The impact is pretty predictable! The scarce resources to drive our health system has been further denuded by the toll of COVID -19 control measures, which have been huge, because the infrastructure needed to manage COVID patients, that is, functional isolation centre’s, where mostly non existent and had to be all put together, culminating in huge initial take off costs.

“Ventilators, which constitute the mainstay of management of late stage cases requiring urgent care, were also unavailable/inaccessible with dearth of qualified staff familiar with their use! All these challenges, inclusive of the capital intensive expenditure it attracts, all contributed to deny cancer control what it needed to ensure stability of the management of cancer patients!”

Okoye, who is also known as ‘Pinky Prof,’ is the founder of Breast Without Spot. She said another major challenge is out-of-pocket payment by cancer patients, which runs to almost N18 million as initial cost for a new patient with breast cancer.

The oncologist said cancer patients had attendant reduction of their immune system integrity and thus are high risk to fall into the over 63 per cent mortality associated with population of COVID-19 patients that are ventilator dependent.

A cancer expert at the Institute of Human Virology Nigeria (IHVN), Dr. Augusta Imomon, confirmed that COVID-19 has had a negative impact on their research on breast cancer.

Imomon said: “We had to get ‘a six-month no pay extension’, from our funders, following the delay in getting ethical clearance and also on training our study staff, as a result of the lockdown during the first wave of the virus in Nigeria.

“My personal experience was that moving pathology specimen to centers outside the country, linked to the studies by material transfer agreement, was impossible! Non of the courier companies, was willing to touch human tissue, due to risk of transmission!”

MEANWHILE, another paper, published online by Cancer Cell, represents the most comprehensive survey to date about what physicians have learned, and what research is suggesting about the interrelationship between the two diseases.

Co-lead author of the study, Dr. Ziad Bakouny of Dana-Farber with Jessica Hawley, of Columbia University Medical Center, United States, said: “COVID-19 has been responsible for killing more than one million people worldwide. Among those most at risk of developing severe forms of the illness are patients with cancer.”

In patients with cancer, COVID-19 can be especially harsh. This is likely because many patients have a weakened immune system, either as a result of the cancer itself or the therapies used to treat it. They are therefore less able to fight off infection by the novel coronavirus. Several studies have examined whether systemic cancer therapies such as chemotherapy and targeted therapies increase patients’ vulnerability to COVID-19.

One of the most dangerous consequences of COVID-19 is an overaggressive immune response known as a “cytokine storm,” which can damage lung and other tissues. Patients with cancer treated with immune-stimulating therapies such as immune checkpoint inhibitors, chimeric antigen receptor (CAR) T-cell therapies and bi-specific T-cell engagers (BiTEs) are at risk of complications if the immune response produced by these therapies results in an attack on normal, healthy tissue. Patients treated with CAR T-cell therapies and BiTEs, in particular, can develop a side effect known as cytokine release syndrome, which is similar to the cytokine storm in patients with COVID-19. Researchers have theorised that COVID-19 could exacerbate cytokine release syndrome in patients treated with certain immunotherapies, but studies have not definitely shown that this is happening, the new report states.

Despite these challenges, investigators found a variety of ways to adapt to straitened circumstances so trials could continue. These include leveraging telehealth to limit in-person visits, use of e-signatures for trial documentation, shipping oral medications to trial participants rather than requiring them to be picked up at the clinic, and allowing laboratory tests to be done at outside labs.

Established in 2000, World Cancer Day is held every 4th February and is the global uniting initiative led by UICC. By raising worldwide awareness, improving education and catalysing personal, collective and government action, supporters of World Cancer Day are working together to reimagine a world where millions of cancer deaths are prevented and access to life-saving cancer treatment and care is equal for all.

ALSO, new cancer cases have increased in the African Region from 338,000 cases reported in 2002 to almost 846,000 cases in 2020, over the past 20 years, according to WHO.

The organisation’s Regional Director for Africa, Dr. Matshidiso Moeti who disclosed this yesterday, stated that the rising cancer burden would place additional pressure on resource-constrained health systems and on patients and their families who incur heavy costs to access services.

She said: “The African Region bears the highest burden of cervical cancer among WHO regions, and the World Health Assembly’s adoption in 2020 of the Global strategy to accelerate the elimination of cervical cancer as a public health problem was of key relevance to African countries.

Moeti also noted that in many communities in African countries, people had limited access to cancer screening and early detection, diagnosis and treatment. For example, only about 30 per cent of African children diagnosed with cancer survive, compared to 80 per cent of children in high-income economies. Challenges in access to cancer care are further compounded in times of crisis, like the current COVID-19 pandemic.