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Such efforts attempt to ease the difficult situation of being stuck between cancer and COVID-19, but one question still lingers around; which one is the rock and which is the hard place.

Profile picture of DPhil student, Ranin Soliman

Between a rock and a hard place, is an idiom referring to being faced with two equally undesirable alternatives and the dilemma of being stuck in a difficult situation where one needs to make a hard decision.  This pretty much portrays the position of dealing with cancer amidst the COVID-19 pandemic. Both, together, seem to have a synergistic effect on inferior health outcomes, where the damage caused by the existing conditions combined would be greater than each of them individually. A multicentre study during the COVID-19 outbreak found that cancer patients appear more vulnerable to COVID-19 and are at higher risk for all severe outcomes. Concurrently, another study suggests that cancer mortality could rise at least 20% because of the pandemic.

Cancer and COVID-19: 3 dimensions (3D) of the problem

A global COVID-19 and Cancer Taskforce was established to assess the impact of COVID-19 on cancer outcomes worldwide. It was suggested that COVID-19 could have negative effects on cancer from three different dimensions (3 research themes);

  1. direct impact on cancer outcomes (morbidities and mortalities) and treatment disruptions;
  2. adverse impact on cancer diagnosis due to lockdown measures, and on screening due to shifting focus from cancer control programmes to COVID-19; and
  3. long-term impacts of COVID-19, on increased cancer risk and lower prevention measures.

Collaborative initiatives for cancer and COVID-19 registration

A number of initiatives and registries were launched to collect data about cancer patients with COVID-19 and/or to study the impacts of the pandemic on cancer care and outcomes. The COVID-19 and Cancer Taskforce Global Modelling Consortium aims to develop a global modelling platform that synthesizes and disseminates data on how the COVID-19 pandemic is affecting cancer outcomes worldwide. The ESMO-CoCARE Registry gathers data from healthcare professionals about treatment approaches focusing on the impact of SARS-COV-2 on cancer patients. Besides, the Global Registry of COVID-19 in Pediatric Cancer reports childhood cancer cases with lab-confirmed COVID-19. Furthermore, the COVID-19 and Cancer Consortium (CCC19), a consortium of cancer centers, developed a survey to collect data about cancer patients with COVID-19.

A need for better evidence for the tough decisions ahead

As a contribution to the global efforts to tackle the critical issue of dealing with cancer during COVID-19, high-quality evidence is needed to better understand the impacts of the pandemic on cancer control and outcomes, and help guide the difficult choices and decisions ahead.

This could be realized through joint efforts between evidence-based medicine (EBM) and oncology experts and researchers to critically appraise the available evidence, assess potential risks of bias, and evaluate the applicability of research results in practice. EBM researchers with critical appraisal capacities can make significant contribution by conducting rapid reviews and systematic reviews to generate the needed evidence about the impacts of COVID-19 on cancer care and outcomes, and how this can guide informed decision-making. This helps generate evidence-based recommendations regarding cancer care and COVID-19 and guide informed decision-making with implications on practice and policy.  This is a call for establishing a Cancer and COVID-19 Evidence Synthesis Group that would be dedicated for this mission and contribute to the global efforts of addressing Cancer and COVID-19.

Such efforts attempt to ease the difficult situation of being stuck between cancer and COVID-19, but one question still lingers around; which one is the rock and which is the hard place!


Disclaimer: the article has not been peer-reviewed; it should not replace individual clinical judgement and the sources cited should be checked. The views expressed in this commentary represent the views of the authors and not necessarily those of the host institution, the NHS, the NIHR, or the Department of Health and Social Care. The views are not a substitute for professional medical advice.

Ranin Soliman is a doctoral researcher in Evidence-based Healthcare, based in the Department for Continuing Education at the University of Oxford.