People who have been diagnosed with cancer are more likely to adhere to recommended precautions to prevent COVID-19, but this may lead them to cancel appointments for needed medical care, according to research presented last week at the American Association for Cancer Research COVID-19 and Cancer virtual meeting.
Although people with cancer are not necessarily more likely to contract SARS-CoV-2, the new coronavirus that causes COVID-19, most studies show that they are more likely to develop severe illness and die from it. What’s more, cancer patients and survivors are often older and have coexisting medical conditions that make them more vulnerable to the new disease, and certain cancer treatments can lead to immune suppression.
Jessica Islam, PhD, MPH, of the University of North Carolina Lineberger Comprehensive Cancer Center, and colleagues evaluated COVID-19 prevention behaviors among cancer survivors—defined as anyone with a self-reported prior diagnosis of cancer—in the United States. In particular, they looked at whether survivors cancelled or postponed their doctor appointments.
To reduce coronavirus exposure, the Centers for Disease Control and Prevention (CDC) and other public health authorities have recommended preventive measures including maintaining physical distance and wearing face masks, especially for people at high risk. The CDC also advised avoiding “nonessential” medical visits, which may present a barrier to continuity of care for people with cancer, the researchers noted as background.
Islam’s team analyzed nationally representative data from a sample of 10,760 U.S. adults who participated in the COVID-19 Impact Survey, conducted by the University of Chicago. Data were collected during in three phases: April 20 to 26 (Week 1), May 4 to 10 (Week 2) and May 30 to June 8 (Week 3). Of these, 854 (7.6%) participants said they were cancer survivors.
Over half of study participants were women and a majority were married or living with a partner. Three quarters were white, and 65% were age 60 or older. A third were employed, about half made less than $50,000 annually, and 56% were insured through Medicare.
During the weeks of the study, cancer survivors were more somewhat likely to report several nonspecific symptoms sometimes associated with COVID-19, although fever and cough occurred with similar frequency in both groups.
Cancer survivors were significantly more likely than those not diagnosed with cancer to adhere to most recommended preventive behaviors:
- Washed or sanitized hands: 94% versus 90%
- Kept six feet of distance from people outside their household: 93% versus 84%
- Wore a face mask: 92% versus 84%
- Avoided public or crowded places: 84% versus 76%
- Avoided restaurants: 80% versus 70%
- Canceled or postponed social or recreational events: 74% versus 64%
- Avoided contact with “high-risk” people: 68% versus 58%
- Canceled doctor appointments: 41% versus 30%
- Canceled or postponed dental or other appointments: 41% versus 36%
However, cancer survivors were less likely than those without cancer to report certain precautions:
- Worked from home: 24% versus 32%
- Canceled or postponed work-related activities: 19% versus 29%
- Canceled or postponed school-related activities: 13% versus 20%
- Stayed home because they felt unwell: 9% versus 11%
During Week 1, 35% of cancer survivors and 32% of those without cancer cancelled doctor appointments, a difference that was not statistically significance. But during Week 2 the difference widened (52% versus 32%, respectively), and it remained significant during Week 3 (35% versus 27%).
Although people with cancer were more likely to cancel doctor appointments, they were also more likely to visit a doctor or a hospital (14% versus 9%), perhaps because they had a greater need for care than those without cancer. However, the study was not able to assess whether participants were currently undergoing cancer treatment or whether the visits were related to such treatment.
Cancer survivors ages 18 to 29 were more likely to cancel doctor appointments than other age groups, as were survivors with at least one coexisting medical condition, Islam reported. Black cancer survivors, those who were employed and those living in the west compared with the northeast—where the pandemic was most widespread at the time—were less likely to cancel appointments.
Women with cancer were about 40% more likely to cancel doctor appointments than men, and they were especially likely to do so if their plans were affected by school closures or disruptions in child care. In fact, 57% of women who experienced such disruptions cancelled appointments compared with 40% of those who did not.
“Cancer survivors are adhering to many of the recommended COVID-19 preventive behaviors,” the researchers concluded, but “cancer survivors’ continuity of care may be impacted by COVID-19.”
Islam noted that confusion around guidance about avoiding “nonessential” health care could lead to cancer survivors to avoid essential care. She suggested that health care providers should aim to improve communication with patients to help them determine which appointments are necessary and which can reasonably be postponed.
Click here to see the AACR COVID-19 and Cancer program.
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