A viewpoint published in JAMA Oncology calls on cancer researchers and clinicians to “adjust theoretic frameworks, methodology approaches, and clinical practice to account for the influence of” the coronavirus disease 2019 (COVID-19) or risk overlooking “important factors that now play a role in their research and practice.”
Specifically, the article discusses social distancing efforts and their possible implications for cancer-related health behaviors such as smoking, alcohol consumption, eating, activity and sedentariness. Social distancing could influence these activities, according to Ferrer et al, who wrote, “Individuals who drink or smoke only when socializing may do so less because of bar and restaurant closures—unless their social distancing companions are heavy drinkers or smokers. Moreover, those social distancing alone may drink or smoke more because of loneliness and stress.”
The viewpoint also called for consideration of how social distancing could affect cancer outcomes through its effect on relationships with health care providers and informal caregivers. “Communication in in-person cancer care may be disrupted by increased mask wearing (which can lower trust and connection); consequences of these disruptions may be more pronounced in racially discordant patient-clinician interactions, in which racial bias can already disrupt communication,” Ferrer et al stated.
Additionally, the recent increase in the use of telemedicine should also be considered due to its potential to impact cancer care from a digital accessibility standpoint. For example, the expanded application of telemedicine amid the COVID-19 pandemic might “widen cancer care disparities owing to racial/ethnic inequities in access to electronic devices and software and inadequate attention to cultural tailoring within some telemedicine programs,” according to the authors.
Notably, these shifts are all occurring concurrently with general declines in in-person cancer screening and treatment sought during the pandemic.
“Research not focused explicitly on the pandemic should nonetheless consider its influence on determinants of health behavior and intervention delivery, measuring and accounting for changes in perceived stress, social support, and loneliness,” the authors wrote. “Clinicians should carefully consider how health communication, prevention, and treatment will be affected by less access to health care and racial/ethnic inequalities in care and balance these considerations with infection risk when making screening recommendations and creating care plans.”
Ferrer RA, Acevedo AM, Agurs-Collins TD. COVID-19 and social distancing efforts—implications for cancer control. JAMA Oncol. Published online December 17, 2020. doi:10.1001/jamaoncol.2020.6786