How COVID-19 is threatening cancer care

As unemployment skyrockets and more people lose their health insurance, cancer patients may struggle to access important screenings and treatments.

In this 2015 file photo, a nurse places a patient's chemotherapy medication on an intravenous stand at a hospital in Philadelphia.
AP Photo/Matt Rourke
May 19, 2020, 8 p.m.

From disruptions in treatment to loss of health insurance, cancer patients during the COVID-19 pandemic have had to navigate many new challenges.

Cancer patients are especially vulnerable to the coronavirus, which has killed at least 90,000 people in the U.S. The National Cancer Institute has said patients are vulnerable due to their underlying illness and because chemotherapy can suppress the immune system.

But susceptibility to the potentially life-threatening disease is only one part of the concern for cancer patients. As unemployment skyrockets and more people lose their health insurance, some patients may not be able to afford cancer treatment.

Several cancer-patient advocacy organizations are pressing lawmakers to provide more support to patients by launching a special enrollment period for the Obamacare marketplace, something the Trump administration has refused to do, and increasing federal funding for Medicaid. Advocates are also pushing Congress to provide subsidies so people can keep their employer-sponsored insurance after they’ve been terminated.

“What if someone is fired from their job and they lose health insurance?” said Elizabeth Franklin, executive director of the Cancer Support Community’s Cancer Policy Institute. “Or what if someone’s physician says to them, ‘I see that you work at a grocery store. It’s really not healthy for you to be at that grocery store right now as a cancer patient, so I highly advise that you take time off from work.’”

The Cancer Support Community runs a help line that connects patients to counselors and resource specialists. Franklin said that starting in March, the help line extended its hours from five to seven days a week.

“We are seeing a higher volume of calls than ever before. ... They are worried about not just their insurance premiums, but their rent, utilities, gas to get around,” she said.

A survey released in April by the American Cancer Society Cancer Action Network found that, out of 3,055 cancer patients and survivors, 50 percent had reported an impact to their health care due to the pandemic. Around 38 percent of respondents reported a notable impact on their financial situation, affecting their ability to pay for care.

Many cancer patients who had reported a financial impact said it was due to a job loss or a reduction in work hours, said Amy Farner, project manager of survey administration and analysis at the American Cancer Society Cancer Action Network. “Obviously, if you have less money coming in, you have less money to pay for care, but that also lessens the ability to access health insurance in many cases because we know that health insurance is tied to their employment in many cases, so it’s really a double whammy,” she said.

ACS CAN, along with several other cancer-related advocacy groups, wrote to congressional leaders in April outlining priorities for the next coronavirus package, including ideas to help people get and keep health coverage.

Variations of these ideas were included in the House version of the fourth stimulus package, which passed the chamber last week but has met Republican opposition. The legislation would provide a two-month special enrollment period for the federal government marketplace. Although the loss of job-based coverage already qualifies people to sign up for Obamacare plans, major health groups like America’s Health Insurance Plans say a special one-time enrollment period would also open up the marketplaces to individuals who may not otherwise be eligible.

House Energy and Commerce Committee ranking member Greg Walden criticized the proposal. “The bill throws more good money after bad to the failing enrollment programs in Obamacare,” he said on the House floor Friday.

The bill would also temporarily increase federal government payments for Medicaid. The program is funded by both states and the federal government, but as states are considering budget cuts, the legislation would increase the federal government’s share by 14 percentage points. It would also provide subsidies through January 2021 so workers can keep their employer-sponsored coverage if they lose their jobs.

Groups representing particularly vulnerable populations, including patients with cancer, cystic fibrosis, and diabetes, are also pressing Congress to expand paid family and medical leave so that people who are considered at high risk from COVID-19 can remain home during the pandemic.

“As we reopen the economy, how are cancer survivors and cystic-fibrosis patients going to be well protected?” said Shelley Fuld Nasso, CEO of the National Coalition for Cancer Survivorship. “What if they are recalled to work and working in an environment where they don’t feel that they have adequate protection?”

Protecting cancer patients from COVID-19 exposure has also made patients and doctors reconsider their treatment decisions, and experts say that some treatments were put off earlier in the pandemic.

Otis Brawley, a professor of oncology at the Johns Hopkins University School of Medicine, said that patients at the Johns Hopkins Kimmel Cancer Center who could safely delay their treatment did so. He added that other cancer centers around the U.S. made similar decisions.

“People who could afford to wait, we stopped because we really wanted to see what this virus was,” said Brawley, a cancer-prevention expert. “We didn’t understand, and still to a certain extent don’t understand, a lot of the aspects of the virus.

“Now, we are starting to bring those folks who were in time-out back into oncology,” he added. “I would say within our practice at Hopkins, probably two-thirds of the patients had their treatment interrupted.”

Other experts expressed concern about continued delays in cancer screenings, either due to patients’ fear of being exposed to the virus or because patients have lost their health insurance.

“A lot of the advances in cancer care, prevention, and survival over the last decades have been related to early detection and screening as well as treatment advances,” said Randall Oyer, medical director of the Lancaster General Hospital Ann B. Barshinger Cancer Institute in Pennsylvania and president of the Association of Community Cancer Centers.

“If we lose or diminish the ability to prevent or detect cancer early, people will be coming in when they’re symptomatic or when they have more advanced cancers, making it more difficult to cure them, and setting them up to need more aggressive, more complicated, riskier therapies," Oyer added.

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