Wider Health Impacts of COVID-19 on Patients with Cancer and Other Multiple Chronic Conditions: A Parallel Mixed-Methods Study

The wider effects of the COVID-19 pandemic on the health systems and non-COVID patients only start to be understood. Patients with cancer and other multiple chronic conditions (MCC) are particularly at risk of long-term negative health consequences. Real-world evidence and evaluation on cancer care remains scarce despite a rising number of simulation and modelling studies. Multimorbidity has comparatively received much less attention. Yet, about 25% of the population are living with MCC, and the burden of multimorbidity was already on the rise before the pandemic. Our project aims to measure the potential impact of COVID-19 on patients with cancer and MCC and to identify models of care and innovative interventions that could mitigate these impacts. We will focus on Ontario, the most populous province and severely affected by the first three waves of the pandemic. We adopt a parallel mixed-methods design where we will quantitatively assess the wider effects on the evolution of cancer care trajectory and severity for patients with MCC, and whether some models of care have mitigated these effects better than others; and qualitatively reveal the experiences of these patients, their family, and their clinicians, and identify changes to practice that may have limited the impacts of the pandemic. Results from this project will significantly advance knowledge on the actual (rather than forecasted) impact of COVID-19 on a large group of Canadians particularly at risk of health deterioration, and often marginalized. Deliberative dialogues engaging research, clinical, policy and patient partners in Ontario and other provinces (e.g., British Columbia, Quebec), will be used to maximize transferability of our findings and opportunities for scaling-up mitigation strategies across Canada. Our findings will provide information to feed in new mathematical modelling to improve preparedness for future health emergencies, and a foundation for future multi-jurisdictional studies.