INTRODUCTION
Cancer is a serious disease that affects the lives of millions around the globe.1 Because of the nature of the disease and its treatment, patients with cancer are required to visit health care facilities more than patients with other diseases. The treatment of patients with cancer requires a full involvement of multidisciplinary teams throughout the disease trajectory from diagnosis to survivorship or end-of-life care.2 During the disease course, patients require multiple hospital visits for assessment by different clinicians and to undergo many laboratory or imaging tests for diagnosis, staging, or monitoring of treatment effects in addition to different types of procedures and interventions. Besides medical providers, patients with cancer need the help of many other disciplines, such as social workers, psychologists, educators, and other support services. Once diagnosed with cancer, patients need continued monitoring and support during and after treatment. To achieve the maximum benefits for patients, these services should be working in harmony and a timely fashion, with great commitment and compliance from the patients because any unjustifiable deviation from the well-established standards may lead to fragmented and poor-quality care and worse patient outcome.
CONTEXT
Key Objective
What was the impact of COVID-19 pandemic on cancer care at a global level? How did the magnitude of impact vary in different settings?
Knowledge Generated
Our study revealed that the overwhelming majority (88%) of the 356 participating centers on six continents faced challenges in providing usual cancer care for many reasons, including precautionary measures, an overwhelmed health care system, lack of personal protective equipment, and staff shortage. More than a third of these centers reported patient exposure to harm from interruption of cancer-specific care or other medical care. As expected, the impact was more pronounced in low-income countries. The implementation of virtual communication and remote care were prevalent responses in most centers.
Relevance
The lessons learned from this study may help oncology centers to manage the current pandemic more efficiently and be better prepared for any future crises.  The new coronavirus started as an outbreak in late 2019, and in a few weeks, it became a global pandemic.3-5 This new virus has a high contiguity rate and a fatality rate between 2% and 3%.6-8
Up to June 8, 2020, > 7,000,000 people infected and > 400,000 deaths were reported on a global scale, with large discrepancies in incidence and fatality among countries as reported by the COVID-19 Dashboard of the Center for Systems Science and Engineering at Johns Hopkins University.9
The COVID-19 pandemic affected health care services in many dimensions, starting from interrupting regular patient flow to health care facilities, stressing and overwhelming the health care resources, and leading to the implementation of extra protective measures and social distancing with increased utilization of telehealth and virtual medicine. As a precautionary approach, oncology practices implemented specific measures such as reducing the number of patients in outpatient clinics, reducing unnecessary or elective procedures, and discharging patients from inpatient services.10,11
Patients with cancer are a vulnerable population, and they are prone to many harms during such pandemics, including susceptibility to life-threatening infections and interruption of their cancer or usual medical care. Hence, oncologists have faced a major challenge to balance the delivery of high-quality continuous unfragmented cancer care with minimizing patients’ risk of exposure during care. The negative impact of the pandemic is likely to be greater in low and middle income countries with limited resources, poor infrastructure, shortage of health care providers and organized care teams, scarcity of medical supplies and personal protective equipment (PPE), and poor access to technology12-14—resulting in a lack of ability to provide and deliver critical care.
The responses of oncology centers to the pandemic and interventions implemented were reported on a limited scale by different centers, and reporting was done in general terms. To our knowledge, there is no systematic study that assessed these responses and the impact of the COVID-19 pandemic on cancer care. Our study aimed to evaluate the response of oncology centers and services to the pandemic at a global level and to assess the impact on cancer care delivery and implemented interventions.