“COVID-19 has caused massive disruption to healthcare, one that will reverberate for months and years to come.”
— Komodo Health study
Timely cancer diagnoses, tests, screenings, and standard medical care are falling victim to the COVID-19 pandemic according to a Lancet article published by doctors in the Netherlands on April 30 and a report released by Komodo Health on April 28.
The Lancet paper found “that there is a notable decrease in cancer diagnoses when compared with the period before the COVID-19 outbreak.” In the Netherlands, which has one of the most comprehensive universal health care systems in the world, “national screening programmes for” a variety of cancers are being “temporarily halted…to alleviate the demand on the health-care system due to COVID-19.”
“Routine disease management and preventive screenings have declined significantly,” according to the Komodo Health study, which cited a 21.7% drop of beta-2-microglobulin biomarker testing for myeloma patients in the U.S. “Sharpest declines have occurred in COVID-19 ‘hotspots’ such as New York…Massachusetts…and in California” with some diagnostic tests like the HbA1c test, which measures levels of blood sugar, “down more than 90% from average levels prior to” the pandemic.
“I am concerned about the likelihood that individuals with early signs and symptoms of myeloma are not coming to medical attention during the pandemic,” warned Dr. Tanya Wildes, a myeloma specialist at Washington University in St. Louis, MO. “Myeloma can cause a lot of damage before it is diagnosed, and we have a better shot of reversing the damage, whether to the bones or the kidneys, the earlier it is diagnosed.”
“One must weigh the risks and benefits of delaying or avoiding therapy for myeloma because of the pandemic,” said Dr. Morie Gertz of the Mayo Clinic, one of the authors of a paper recommending COVID-19 treatment guidelines for physicians. “The risks of not treating multiple myeloma for 2 to 3 months runs a very real risk of disease relapse. The mortality rate associated with coronavirus is running about 3%. One has to have perspective in assessing the risks of the disease versus the risk of the current pandemic.”
Dr. Craig Hofmeister of Emory University’s Winship Cancer Institute cautioned that these disruptions make “getting routine medical care even harder, especially in rural communities where blood cancer related expertise can be spread thin…myeloma is like many blood cancers that won't wait, so more patients are likely to show up in emergency rooms with kidney failure and compression fractures instead of just mild anemia and more protein in their blood.”
The authors of the Lancet article urged people not to let the fear of COVID-19 distract or prevent them from seeking medical care because “the treatment for potentially curable cancers with an imminent risk of early death (eg, acute leukaemias) cannot be safely postponed.”
“The findings may have significant implications for future morbidity and mortality,” emphasized the Komodo study, “if delayed tests and screenings generate a wave of poor outcomes in the months to come.”
Dr. Wildes noted that medical centers and hospitals are proactively taking measures to lessen anxiety and protect patients. For example, “radiology departments have put in place procedures to ensure safety, from physical distancing in waiting rooms to increased sterilization procedures between patients.”
Dr. Hofmeister acknowledged “many centers are requiring a 30% drop in face-to-face visits to comply with social distancing.” Dr. Wildes added, “while this has been essential to flatten the curve, there are undoubtedly people suffering from subtle symptoms that they have been managing alone, rather than presenting to their healthcare provider. Someone experiencing persistent fatigue or increasing back pain should check in with the medical provider they had before the pandemic if they have similar symptoms.”
“These reports echo what myeloma specialists have been telling us for the past two months,” said Myeloma Crowd founder and president Jenny Ahlstrom. “This is particularly disturbing for those with undetected myeloma since we know that the first treatment will give patients with their longest remission. There are certainly undiagnosed myeloma patients—as well as with other cancers and diseases—who are not getting vital treatment and care.”
Komodo Health is partnering with Karyopharm in a new trial to explore the use of the oral multiple myeloma drug selinexor (XPOVIO) as a potential therapy for hospitalized COVID-19 patients.
about the author
Greg Brozeit has been engaged in myeloma patient advocacy since 1998. He began working with the Myeloma Crowd in 2015. Prior to that, he consulted with Dr. Bart Barlogie at the University of Arkansas after working with the International Myeloma Foundation for 15 years, where he inaugurated the public policy advocacy program, patient support group outreach and IMF Europe, organizing more than 100 physician and patient education programs. He earned his BA in political science from Loyola University in New Orleans and lives in northeast Ohio.