The Tsunami after the Earthquake: COVID-19 Impact on Cancer Care and Outcomes

The COVID-19 pandemic has transformed Canada's cancer system. Beyond short-term disruptions on care delivery, wider and long-term impacts, arising from cancer screening delays, prolonged wait times for treatment, and undermanaged mental illnesses, have not been thoroughly examined. These disruptions will lead to future economic and societal costs, thereby extending the adverse effects of COVID-19 for many years to come. Whether the associated impacts are accentuated in marginalized populations (immigrants, ethnic minorities, lower socioeconomic status regions) are also unknown. To design an effective and equitable cancer system recovery plan, it is imperative to consider these wider, and potentially population-specific, consequences of COVID-19. This proposal addresses this urgent need. This study brings together healthcare leaders, physicians and other stakeholders to assess COVID-19's wider impacts on cancer care delivery and patient outcomes in Ontario. Pre-pandemic and pandemic comparisons will be made related to three specific aims: 1) quantify changes in screening uptake (for cervical, breast and colorectal cancers); 2) measure shifts in cancer staging and managing newly diagnosed cancer patients, including initial treatment modality (surgery, radiation therapy, or chemotherapy) and wait times; and 3) examine patient-reported depression/anxiety symptoms during cancer treatment and subsequent receipt of therapy. Additional analyses will assess if the trends of 1)-3) point to exacerbated disparities in marginalized populations (immigrants, rural residents, individuals experiencing material deprivation, and Indigenous populations). Lastly, through engagement of national/provincial policy leaders and clinical leads, recommendations on how to minimize the impact of the pandemic on cancer care and improve preparedness for future health emergencies will be provided.