IN 2020, a new “big C” crashed into our consciousness. At the peak of its surge in the spring, COVID-19 killed more people per day in the U.S. than cancer, and now rising COVID-19 deaths mean this is happening again. Meanwhile, the pandemic has had a significant impact on cancer patients, even as they continue to face the same serious cancer-related issues they did in previous years. Below, the Cancer Today staff highlights articles that shed light on cancer in 2020.

Experts Push for New Cancer Drug Dosing Recommendations
Undark, Dec. 9

A cancer diagnosis brings a host of decisions large and small, often spread out over months or years. In such a scenario, patients might take comfort in things that seems immutable or indisputable, like the black-and-white text printed on their pill bottle—but unfortunately, even that isn’t always so straightforward. A feature story published on Undark follows oncologist Mark Ratain as an offhand inquiry about drug labeling turns into a larger inquiry into dosing schedules. It’s tempting to believe that the ideal conditions to allow a treatment to work at its best are crystallized before the drug is approved by the Food and Drug Administration. But as this feature reveals, new information can sometimes contradict the scientific consensus, and dosages designed to maximize effectiveness for most patients may not suit the needs of each individual. While work is being done to ensure that new drugs are given efficient dosing schedules that eliminate waste and the potential for damaging side effects, even these measures may not affect dosages for drugs that are already on the market.

What Happens to Black Cancer Patients
Elemental, Dec. 9

When Shekinah Elmore’s father was hospitalized for pain related to suspected prostate cancer, Elmore flew across the country to be with her family. A medical resident training to be an oncologist herself, Elmore spoke to the oncologist about her father’s diagnosis and treatment options. “When the oncologist left, my mother looked at me and said ‘Is that how doctors talk to each other?’ It was clear that she meant ‘with respect.’ I hung my head,” Elmore writes. In an essay published in Elemental, Elmore describes the racism and inequitable treatment her father has experienced as a Black patient and she has experienced as a Black doctor. In the hospital before Elmore arrived, doctors told her parents her father’s cancer “was everywhere” and that he would need surgical castration, when in fact it appeared to have spread to one lymph node and he had multiple treatment options. “What would have happened if my parents did not have an oncologist-in-training as their daughter?” Elmore asks. “What happens to all of the patients that are not seen as equal partners in their health care choices? What happens to the Black patients?”

As a Kid, His Factory Work Paid for His Dad’s Cancer Care. As an Oncologist, His Research Offers More Than Survival
STAT, Nov. 24

Journalist Eric Boodman tells the story of Mutlay Sayan, a radiation oncology resident in New Jersey who grew up in Turkey working first in his parents’ cotton fields and then as a child laborer in a factory in Istanbul. Sayan’s family had moved to Istanbul so his father could be treated for cancer. The factory was next door to a school, and Sayan managed to talk his way into a scholarship to study there, ultimately leading to his career as a doctor. Today, Sayan treats patients and studies how to improve quality of life and access to care. His experiences present an inspiring story about a talented person who is making a difference in the world. But Boodman challenges us to think about the political underpinnings that determine who we accept into our country and whether patients get good care. “Sayan’s is the kind of story America loves, a bildungsroman of possibility. We all want to see ourselves in him—at once brilliant and warm, fun to talk to, tirelessly pursuing something deeply moral and worthwhile,” he writes. “We never imagine ourselves in the role of the factory owner, turning a blind eye as our employees bleed.”

Colon Cancer Screening Should Start Earlier, at Age 45, U.S. Panel Says
New York Times, Oct. 27

The U.S. Preventive Services Task Force (USPSTF) released draft guidance on Oct. 27 that lowers the age for the start of routine colorectal cancer screening from 50 to 45. The change reflects rising rates of colorectal cancer in younger adults. The draft recommendations say that screening should begin at age 45 for people at average risk of developing colorectal cancer who are not experiencing symptoms, and they single out Black Americans for being at heightened risk of colorectal cancer. “Lives will be saved,” said researcher and medical oncologist Kimmie Ng, director of the Young-Onset Colorectal Cancer Center at the Dana-Farber Cancer Institute in Boston, in a New York Times report. “We will be preventing cancers in young people, catching them at an earlier stage when they are more likely to be curable and hopefully improving survival rates.” Medical oncologist Scott Kopetz of the University of Texas MD Anderson Cancer Center in Houston told the Times, “One in three of our patients now that we’re seeing are under 50. It’s a major issue.” The USPSTF is an independent group of experts that provides guidelines on preventive care followed by physicians and used by health insurance providers to determine coverage.

He’s 32. He’s Joe Biden’s Press Secretary. And He Has Stage 4 Cancer.
Washingtonian, Oct. 16

A presidential campaign may revolve around an individual candidate, but it can take a cast of thousands to reach the finish line. TJ Ducklo served as the national press secretary and a top spokesperson for Joe Biden’s successful attempt to become the next U.S. president. But in December 2019, just a month before the potentially pivotal Iowa debate, Ducklo was diagnosed with stage IV lung cancer. Not everyone who is diagnosed with cancer has to worry about playing their part in a presidential campaign, but everyone with cancer has a life outside of the disease. Ducklo’s story reminds readers that cancer doesn’t care about other plans, but with favorable circumstances like good health insurance, a solid financial foundation and the support of the people around you, life may not have to grind to a complete halt following a diagnosis.

Do Tattoos Cause Cancer? The Making of the Stupid Stuff People Say to People Living With MBC
A Story Half Told, Oct. 13

Laughter as a form of resiliency takes center stage in a video that pokes fun at the insensitive things people say to those who have metastatic breast cancer (MBC). Highlighting the experiences of five people with MBC, A Story Half Told, an advocacy website and campaign backed by drug manufacturer Pfizer and patients support groups to help increase knowledge of this disease, gets to the heart of these sometimes maddening responses without being macabre or melodramatic. Instead, the interactions and laughter of the five people, one of whom died this year, offer a truthful and touching portrayal of what it’s like to live with a lethal disease, and are a testament to the power of documenting those feelings and leaving a legacy. “The five of us bonded over the diagnosis we share, and we found ourselves in stitches time and again at the absurdity of the stupid stuff people (really do) say to people living with MBC,” writes Beth Fairchild, a metastatic breast cancer patient and founder of A Story Half Told who describes the process of making the video on the organization’s website. “Only another person living with the disease could help us find humor in the irony and the tragedy of it all. Sometimes we have to laugh to keep from crying.”

At 31, I Have Just Weeks to Live. Here’s What I Want to Pass On
Guardian, Sept. 7

In April, Elliot Dallen wrote an opinion piece for the Guardian in which he discussed his diagnosis with adrenocortical carcinoma and the process of coming to terms with the fact that he was unlikely to survive past the end of the U.K.’s lockdown caused by COVID-19. In September, the Guardian published another article by Dallen, reflecting on his actual experience of lockdown and the response to his first piece. He writes frankly about the positives he was able to take away from the previous months without shying away from the grim reality of facing a terminal illness at 31 years old. In one particularly poignant section, he imagines how his life might have progressed without cancer. Dallen died the night his second article was published, but the perspectives he imparted in his final months will no doubt be shared among people affected by cancer for many years to come.

Liquid Biopsy Field Moves Forward but Faces Hurdles
OncLive, Sept. 2

The promise of using a sample of blood as a way to detect and learn about cancer in the body has long been held out as a way to transform cancer diagnosis, treatment and screening. In 2020, two Food and Drug Administration approvals of these liquid biopsy tests—the FoundationOne Liquid CDx test and the Guardant360 CDx test—brought these technologies to the fore. The tests were approved to detect multiple mutations in various solid tumors. But challenges remain, including expanding physicians’ understanding of the limitations of liquid biopsies. “I think liquid biopsy is being used a lot more widely in the community oncology setting than most people appreciate, but I don’t know if it’s being used most judiciously in those settings [because] the research is somewhat outpacing the general medical oncologist’s understanding of what these tests are actually doing and showing,” Andrew McKenzie, director of personalized medicine at Sarah Cannon, a cancer institute in Nashville, Tennessee, told OncLive. “I think there’s a significant education gap right now, and if we solve that education gap, we would be able to make a lot more sense out of what these tests are showing us.” Cancer Today also explored this topic in its winter issue, further describing recent applications of this tool in the clinical setting.

Targeted Treatments Help Reduce Death Rates for Most Common Lung Cancer, Study Finds
Washington Post, Aug. 12

New targeted drugs that treat non-small cell lung cancer (NSCLC) are associated with a significant improvement in survival among patients with the condition, according to a study published in the New England Journal of Medicine. The Washington Post reported that death rates for men with NSCLC, a condition that accounts for 76% of U.S. lung cancer cases, declined faster than NSCLC incidence rates from 2013 to 2016. Researchers said these findings indicate that patients benefited not only from reductions in smoking that prevented people from getting cancer in the first place, but also from new treatments that reduced mortality in people who did develop cancer. In addition, the annual decline in mortality rates for NSCLC during this time was nearly double the annual decline in the prior seven years, the study found. By contrast, mortality rates for small cell lung cancer (SCLC), which accounts for about 13% of lung cancer cases, decreased at about the same rate as SCLC incidence rates from 2013 to 2106, indicating that smoking reduction was the primary factor. Also, fewer new treatments have been developed for SCLC than for NSCLC. Lung cancer researcher and medical oncologist Roy Herbst of Yale Cancer Center in New Haven, Connecticut, who was not involved in the study, told the Post, “We are making progress in this leading cause of death. But it’s not nearly good enough. We still have a lot of work to do.”

Advice From a Woman Who Survived COVID-19, the 1918 Flu—and Cancer
Washington Post, Aug. 3

The year has brought each of us challenges we could not have expected as we started the new year in 2020. The story of 102-year-old Mildred Geraldine “Gerri” Schappals, who is living in the Huntington at Nashua, a retirement and assisted living community in New Hampshire, provides historical context for our angst. Schappals, who was not particularly health-conscious over her life, survived the 1918 flu pandemic, breast cancer and colon cancer, and most recently COVID-19. Schappals attributes her longevity to her exposure to the 1918 flu pandemic when she was an 11-month-old baby. “I really think that having the 1918 flu strengthened everything about me,” she said. “I never had colds or illnesses until I got cancer, and even then I pulled through. It’s either that or Mother Nature thinks I died in 1918, so she ignores me.” Schappals’ sharp wit keeps staff and residents entertained, notes Lisa Valcourt, the executive director of the Huntington. “She’s been through so much in her lifetime,” Valcourt says. “When you look at everything that she’s been through and her positive attitude that she’s maintained, it makes all of us want to be stronger.”

Too Much Sitting Raises Your Risk for Cancer, Study Finds, June 18

A study published in JAMA​ Oncology found that spending more time being sedentary was associated with a higher risk of dying from cancer. Replacing sedentary time with physical activity was correlated with reduced cancer mortality, according to the study of 8,002 Americans over more than five years. The amount of activity was measured using accelerometers worn by study participants during waking hours for seven consecutive days. Moderate to vigorous physical activity showed a greater correlation with reduced cancer mortality than light physical activity. “This is the first study that definitively shows a strong association between not moving and cancer death,” study lead author Susan Gilchrist of the University of Texas MD Anderson Cancer Center in Houston told CNN. “Incorporating 30 minutes of movement into your daily life can help reduce your risk of death from cancer.”

“For Now, We Wait”: Postponing Cancer Surgery During the Coronavirus Crisis
New Yorker, April 22

For cancer patients, 2020 has been a year punctuated by reports of postponed care and hospitals stressed by COVID-19. In an essay published in the New Yorker, Alessandra Colaianni takes us​ inside a Boston hospital in the early days of the pandemic. At the time, Colaianni was an ear, nose and throat surgery resident. She describes a period of rapidly shifting information and policies. One morning, an elderly woman with salivary gland cancer and her husband showed up for her surgery, and Colaianni had to tell them all surgeries had been canceled. “They’d woken up before dawn; they had driven for hours. But they took the news in stride,” Colaianni writes. Later, a man came in with a bleeding tumor on the back of his tongue. Ordinarily, he would have received an immediate biopsy and a direct laryngoscopy to examine his mouth, throat and voice box. But he was found to have COVID-19 and the doctor decided to postpone the procedure unless he started bleeding dangerously again. Meanwhile, Colaianni’s partner’s cousin, a chef, had her breast cancer surgery postponed. “Like our patients, we are in a holding pattern: The chef takes her hormone therapy, the case board stays mostly empty and my patient with the tongue tumor remains hospitalized. ​For now, we wait,” Colaianni writes. Eight months after the article’s publication, cancer centers say they are better prepared with more personal protective equipment and better infection control procedures. Yet more recently, familiar and alarming headlines have popped up: The Hospital Stopped My Cancer Treatment to Make Room for Pandemic Overflow and A Cancer Patient Needed Critical Care. Because of the COVID-19 Surge, She Died Without It.​​​