• Marcio Alvarez-Silva, PhD

COVID-19 and the cancer patient: vulnerabilities and concerns

With the boom of COVID-19 in the world, many public health priorities have quickly turned to patient care due to the urgency and severity of the disease. According to the World Health Organization, older people and/or any age with pre-existing conditions (such as heart disease, diabetes, respiratory conditions) are more likely to develop serious medical complications related to COVID-19. Cancer patients are a very high risk group for COVID-19. They are already more vulnerable to infection because of their disease, and as they are often immunosuppressed, they are at high risk of developing serious coronary artery disease complications. The Lancet published an interesting editorial: Redefining vulnerability in the era of COVID-19 [https://doi.org/10.1016/S0140-6736(20)30757-1]. This editorial discusses the degree of exposure to coronavirus and vulnerability to the disease: "Vulnerable groups are those who are disproportionately exposed to risk, but those who are included in these groups may change dynamically". Changes in social groups are the result of social distancing strategies. Social groups previously not considered vulnerable at the beginning of a pandemic may become vulnerable depending on the political response adopted by each country to combat the pandemic. The immediate recruitment of various health professionals and community action members to combat the pandemic logically placed them in the front line of the fight against the pandemic and consequently also included them as a group of high vulnerability to OVID-19. As a result, many of these professionals became ill from exposure to the virus. Approximately 20% of the workforce against the pandemic needed to be removed and isolated on suspicion of COVID-19 in the UK [https://doi.org/10.1016/S1470-2045(20)30240-0]. Each country has its own health policies. From one hour to the next, the health system in several countries had to learn and develop strategies to deal with the pandemic. This had an impact on how hospital care had to be redeployed to meet the high demand for patients that was established in hospitals around the world. This has not prevented the collapse of the healthcare system. The very large number of patients requiring isolation and special care in the face of the severe respiratory condition of COVID-19 overloads the established capacity of health systems in several countries. In order to try to reduce the impact on the collapse of the health system, the recruitment of professionals from the most different areas of health and volunteers to join the patient care teams with COVID-19 has been an important strategy. The integration of health professionals to join the forces to fight the pandemic has brought very worrying situations for cancer patients: 1) the number of professionals for oncologic treatment and clinical support, such as doctors, nurses, pharmacists, auxiliaries, nutritionists and psychologists, has decreased significantly, and 2) the large number of these professionals have also become ill as a result of fighting the pandemic. We must also consider that a large proportion of health professionals have had their health deteriorated due to the strong physical and psychological stress to which they have been subjected in their jobs. Certainly, in the midst of the COVID-19 pandemic, the vulnerable groups are not only the elderly, people with illnesses and comorbidities, or homeless people, but also people with mental or physical difficulties to deal with the pandemic [2]. The workload of health workers to cope with the pandemic has a strong impact on the workforce and care for cancer patients. "The pandemic has meant a transformation of all aspects of cancer treatment, regardless of treatment, inpatient or outpatient, and radical or palliative intention," said James Spicer (Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK) [https://doi.org/10.1016/S1470-2045(20)30240-0]. As many health care professionals were recruited to fight COVID-19 (and many became ill), this resulted in a decrease in both outpatient and inpatient treatment teams, including the reduction of many procedures such as surgery, radiotherapy and chemotherapy. The high risk of exposure of the oncologic patient in the hospital environment and the decrease of the clinical staff for care are reasons of great concern, since we do not have, in most countries, a policy for performing simpler procedures at home level.

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