Bridging gaps and building bridges to navigate healthcare avoidance


The current paradigm to strive to diagnose and treat diseases early and effectively remains unquestionable. However, COVID-19 has challenged this central dogma and left us with an unparalleled growing global healthcare crisis.

Reports are clear that the pandemic is creating numerous ripple effects for patients who are facing delays to both the diagnosis and treatment of their chronic conditions, with worrying consequences. None more so than in oncology.

Emerging data inform us that COVID-19 has had and continues to have a profound impact on cancer care globally, leaving survivors at-risk for poor outcomes. A US survey reported that in the early weeks of the COVID-19 pandemic alone, nearly half of all breast cancer survivors experienced delays in their cancer care;1 an observation that has been echoed across a number of tumor types. Population-based modelling indicates that in the UK, compared with pre-pandemic figures, deaths in the first 5 years following a diagnosis are expected to rise by 7.9–9.6% for breast cancer, 15.3–16.6% for colorectal cancer, 4.8–5.3% for lung cancer, and 5.8–6.0% for esophageal cancer. Overall, in comparison to pre-pandemic figures, this equates to more than 3,621 additional deaths and an estimated total additional years of life lost of approximately 63,000 years due to these cancers in the first 5 years after diagnosis.2 Sadly, these predictions have already started to translate into an uptick in COVID-19-related mortality figures. In the US alone, as early as May 2020, estimates of excess deaths as a result of COVID-19 among US cancer survivors over the age of 40 exceeded 30,000.3 This is a figure that will most likely continue to increase—particularly with any future waves of the pandemic.

While many of these figures may reflect global healthcare capacity issues, changes in health-seeking behaviors suggest that healthcare avoidance may also contribute to these sobering statistics.2 Drivers for such behaviors include changes in perception of personal risk and emotional resilience. Again, vulnerable groups with pre-existing health conditions, such as those with cancer, are likely to experience worse outcomes.2 Findings from a UK survey in women with breast cancer indicated that the disruption in the UK’s oncology services has led to increases in both COVID-related and general emotional vulnerability, including an increased risk of developing affective disorder, such as symptoms of anxiety and depression.4 This is particularly poignant this month, as October is when advocacy groups call for us to recognize both Breast Cancer Awareness Month and World Mental Health Awareness day. Furthermore, minority patients may be at an amplified risk to not receive timely access to healthcare (for more on the impact on black, Asian and ethnic minority healthcare issues, see COVID-19: What the looming mental health crisis means for health inequalities).

As healthcare communicators we can play our part in raising awareness to of the importance of getting appropriate care at the right time, whether that’s in the current wave of the pandemic, the next wave of the pandemic, or any other future healthcare emergencies. As part of this, we can provide tailored information for patients, primary care and secondary care health care practitioners to elevate the awareness of the potential risks of healthcare avoidance and to communicate plans to help promote emotional resilience. Our aim should be to help reset the current trajectory by mitigating further potentially avoidable COVID-related deaths and to improve mental health in vulnerable populations.

Looking to increase awareness of the importance of a timely diagnosis and access to treatment, across different conditions? We can help.


  1. Papautsky EL and Hamlish T. Breast Cancer Res Treat. 2020 Aug 9;1–6.
  2. Maringe C et al. Lancet Oncol. 2020 Aug;21(8):1023–34.
  3. Lai A G, Pasea L, Banerjee A et al. medRxiv. 2020. Accessed October 2020.
  4. Swainston J et al. Front. Psychol. 24 August 2020. Assessed October 2020.

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