The Impact Of Covid-19 On Cancer Treatment Delivery In Sub-Saharan Africa

Background: There is limited data on the impact of COVID-19 on cancer care in sub-Saharan Africa (SSA). Here, approximately 14 months into the pandemic, we report survey results to understand how the delivery of cancer care has changed in SSA. Methods: We created a global consortium of cancer specialist from Africa and North America to collect data related to COVID-19 and cancer care in SSA. This abstract represents the results of a survey to consortium members, and other colleagues, from 8 cancer centers in Ghana, Nigeria, Kenya, Ethiopia, South Africa, Rwanda, and Zimbabwe. The survey was completed in February 2021. Results: All sites report relatively low rates of confirmed SARS-COV-2 infection (range, 0-83 cases) with a wide range in the case fatality rate (0-50%). With a median duration of 2.3 months (IQR.9-4.2 months), all sites report a temporary lock down with no (12.5%), minimal (12.5%), moderate (50%) and severe (25%) impact on patient care. Examples of this impact include intra-city travel restrictions (25%), inter-city travel restrictions (62.5%), and excessive patient travel costs (75%). Most sites report changes in radiation therapy (RT) delivery strategies including transition to hypofractionation (50%), selection of single fraction RT for metastasis palliation (62.5%), deferral of RT for low-risk adjuvant situations (37.5%), or no change (25%). Changes in chemotherapy delivery strategies include transition to oral options (37.5%), use of hormone therapy over chemotherapy (37.5%), deferral of palliative chemotherapy (50%), and delivery of RT without concurrent chemotherapy (12.5%), or no change (50%). A total 3 sites (37.5%) reported the existence of breast or cervical cancer screening programs prior to the pandemic. Only one site reported return to pre-pandemic levels of cancer screening. HPV vaccination programs were active at 2 sites prior to the pandemic with only partial recovery at one site. Conclusions: The pandemic has challenged cancer patients despite relatively low rates of reported infection and death. To minimize transmission, oncologist utilize treatment strategies minimizing patient time in hospital. The negative impact on the limited screening and preventative services in SSA is concerning for an impact that may continue for years to come. Legal entity responsible for the study: The authors. Funding: Pfizer. Disclosure: K. Merrell: Non-Financial Interests, Institutional, Research Grant: Pfizer;Non-Financial Interests, Institutional, Research Grant: AstraZeneca;Non-Financial Interests, Institutional, Research Grant: Varian;Non-Financial Interests, Personal, Member of the Board of Directors: Global Access to Cancer Care Foundation;Non-Financial Interests, Institutional, Research Grant: Novartis. All other authors have declared no conflicts of interest.