1. Urgently Address the Cancer Backlog

Based on reports received by the European Cancer Organisation from patient organisations and healthcare professionals across Europe, the harmful impacts to cancer services prompted by the COVID-19 pandemic have occurred across the entire cancer care continuum⁴. Importantly, modelling studies conducted in several European countries predict a risk of thousands of excess deaths in patients with cancer, due to these disruptions^5,6,7,8. Adverse impacts of the pandemic on cancer patients and services include the
following:

• Prevention programmes, including Hepatitis B virus (HBV) and Human Papillomavirus (HPV) vaccination, were stalled, with consequent concern about how catchup can realistically occur⁹;

• Cancer screening and early detection services were suspended in many countries, with uncertainty on how quickly the subsequent backlog could be expedited^10,11. The impacts on cancer screening alone will be significantly detrimental to a broad range of cancer types, notably including breast, cervical, colorectal^12,13, prostate and lung cancer¹⁴.

• The emergency situation that COVID-19 has prompted in health services has deterred European citizens with potential symptoms of cancer from seeking medical advice, potentially leading to significant numbers of missed and later diagnoses of cancer, and raising concerns of an increased cancer burden and poorer cancer outcomes in the coming years^15,16,17,18.

• Accumulating reports have been received of delays in the provision of all modalities of cancer treatment^19,20, and of impaired continuity of cancer care, including delivery of follow-up care as well as management of long-term impacts of cancer and comorbidities;

• Recruitment and conduct of clinical trials and discovery research to underpin new diagnostic and therapeutic development have also been severely affected;

• As a result of the pandemic, pre-existing inequalities in cancer and healthcare have been widened²¹.

Quite apart from these system challenges, the COVID-19 pandemic has imposed enormous emotional strain on cancer patients, their families, partners and carers. This includes the impacts of social isolation, family disruption, and occupational and financial challenges. Additionally, delays in cancer diagnosis are likely to lead to increased presentations with advanced disease and poorer prognosis, in which case patients and their families are faced with more complex decision-making because of resource constraints.

Furthermore, decreased availability of outside support has placed a significantly increased burden on caregivers, left alone to take care of cancer patients. Processes of grief, including anticipatory grief, for individuals, families, and their providers have also been enormously disrupted due to strict restrictions on visits to homes, health facilities and participation in funerals²². Altogether, these elements are exacerbating psycho-social distress and a sense of powerlessness, highlighting an urgent need for the promotion of psychosocial care of cancer patients, caregivers and families during the pandemic^23,24.

Recommendations

The European Commission and WHO Europe should foster continual and urgent sharing of best practices to help national health systems enhance the capacity of cancer services to meet the diagnostic and treatment backlog caused by the COVID-19 pandemic. European best practices must notably include:

• Ways of remodelling vaccination campaigns (e.g. drive-in vaccination centres);

• Innovative methods for maintaining delivery of screening programmes (e.g. deployment of mobile screening units);

• The best means of prioritising the delivery of elective life-saving cancer treatment;

• The creation of dedicated and safe pathways for cancer patient care, taking account of the COVID-19 pandemic scenario;

• Strategies for reducing the bureaucratic burden associated with clinical trials, which otherwise hamper the conduct of research during, and on, COVID-19^25,26.

A “Building Back Better COVID-19 Cancer Response” should be an immediate action of Europe’s Beating Cancer Plan.

It should be constructed in cooperation with cancer patients and all relevant health professionals, drawing together the best practices and guidelines already identified by expert groups in the cancer community^27,28.

This would create an immediate means for providing official EU guidance to health systems on achieving the promptest normalisation of cancer services, and might also be developed in conjunction with WHO Europe.

We recommend the urgent creation of a distinct programme of research, under the new EU Cancer Mission and Horizon Europe programme, to address significant knowledge gaps about the impact of COVID-19 on cancer care and cancer patients.