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The issue of mental health has been brought to the forefront of public consciousness. Social distancing, lockdowns, and fear of infection have all had a significant impact on mental health, with many individuals experiencing increased stress, anxiety, and depression. No longer a taboo, the pandemic has highlighted the critical importance of mental health, and the necessity to address these mental health challenges to ensure patients receive the best possible care and support. The mental health challenges faced by individuals living with cancer have been exacerbated during this time. Disruptions in cancer care, including delays in diagnosis and treatment, has led to increased stress and anxiety. In addition, fear of infection has led to increased isolation and social distancing, which can aggravate feelings of loneliness and depression. Mental health is a critical aspect of cancer care, studies 48,49 have shown that individuals living with cancer are more likely to experience psychological distress, including anxiety and depression. This distress can have a negative impact on cancer treatment outcomes, quality of life, and overall wellbeing.


The COVID19 pandemic has had a devastating impact on long term care facilities, bringing into sharp focus the vulnerability of older adults. As healthcare systems adapted to the challenges of the pandemic, many implemented measures to protect older patients, including prioritizing them for testing and treatment. In the elderly, cancer is one of the predominant causes of mortality and morbidity, and its incidence increases with ageing. In 2019, 61% of new cancer cases in Canada was expected to occur among people aged 65 years and older.50 The number of Canadians in this age group has nearly doubled in the past 20 years and is expected to nearly double again in the next 20 years, with a corresponding increase in the number and proportion of older Canadians with cancer.51

As healthcare systems consider the lessons learned during the pandemic, there is an opportunity to translate the prioritization of older patients into improved cancer care for geriatric patients, who often present with comorbidities and compromised organ function and are less likely to receive optimal doses of chemotherapy, or eligible for clinical trials. Despite requiring special consideration with tailored policies and approaches in cancer care, the aging population is often overlooked. Age based disparities in survival, clear patterns of suboptimal treatment and unmet medical, informational, emotional, and physical needs suggest that more work is necessary to optimize care for older Canadians.50


The important influence of sex and gender on health has come to the forefront during the COVID19 pandemic, revealing numerous disparities in healthcare, including the underrepresentation of women in clinical trials. This lack of inclusion has led to significant gaps in our understanding of women’s health, resulting in inadequate treatment options for female patients. 

In a 2014 report, researchers at the Brigham and Women’s Hospital in Boston chronicled the exclusion of women from health research and its impact on women’s health: The science that informs medicine – including the prevention, diagnosis, and treatment of disease – routinely fails to consider the crucial impact of sex and gender. This happens in the earliest stages of research when females are excluded from animal and human studies, or the sex of the animals is not stated in the published results. Once clinical trials begin, researchers frequently do not enroll adequate numbers of women or, when they do, fail to analyze, or report data separately by sex. This hampers our ability to identify significant differences that could benefit the health of all.

Women have been disproportionately affected by COVID19, with higher rates of infection and mortality than men. Despite this, clinical trials for COVID19 treatments have continued to exclude women. In a published study in Vaccines, researchers found that of the 75 clinical trials for COVID19 vaccines only 24% presented their main outcome data disaggregated by sex, and only 13% included any discussion of the implications of their study for women and men. Considering the sex differences in adverse events after vaccination, and the gendered aspects of vaccine hesitancy, these oversights in clinical research on vaccines have implications for recovery from the COVID19 pandemic and for wider public health.52 A gendered lens should be applied when designing research, including determining what data to collect. This includes consideration of how research design and conduct may be explicitly or implicitly sex/gender biased, for example through exclusion of those who are pregnant or breastfeeding, or how research may potentially exacerbate existing sex/gender related disparities or knowledge gaps. Of the studies on COVID19 vaccines, only one examined adverse events related to the reproductive system, and the authors did not disaggregate these findings by sex/gender, or by age. Surveillance studies have also not reported data on menstrual irregularities or fertility, which have been amplified online and by the media.53

WHAT THIS LOOKS LIKE IN THE REAL WORLD. Heart disease is the second leading cause of death of women in Canada,54 and the leading cause of premature death in women (Canada), and half of women who experience a heart attack have their symptoms go unrecognized.55 However only one third of cardiovascular clinical trial subjects are female and only 31% of cardiovascular clinical trials that include women report results by gender and sex according to the Bringham report. And even fewer studies account for the intersectional factors that further impact health such as ethnicity, socioeconomic status, etc. As a result, approaches to prevention, diagnosis, treatment, and care often do not equally apply to women’s bodies, gender identities or roles.54

In 2021, at the height of the pandemic, the World Health Organization (WHO) outlined six (6) priority areas for healthy equity and equality for women’s health.56 These six priority areas include; addressing gender inequalities in the COVID19 response and recovery; elevating the position of women in the health and care workforce; preventing and responding to violence against women; ensuring quality sexual and reproductive health for all; reducing noncommunicable diseases among women; and increasing women’s participation and leadership in science and public health.

Women have historically been excluded from clinical research and the pandemic has further highlighted these disparities, emphasizing the need for more inclusive research, screening and treatment practices.


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