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Tuesday, May 12, 2020

Cancer Trials, Treatment Harmed by COVID-19 Pandemic

By Hal Conick

People with cancer are being affected greatly by the COVID-19 pandemic, according to Howard "Skip" Burris, MD, FASCO, FACP, and so too is the care they receive. As President of the American Society of Clinical Oncology and President of Clinical Operations and Chief Medical Officer at Sarah Cannon, Burris hosted an ASCO online panel called COVID-19 and Cancer: Addressing a Healthcare System in Crisis.

Case in point to cancer's impact on cancer: Burris noted that approximately 60 percent of clinical cancer trials have halted or stopped entirely because of COVID-19.

Richard Schilsky, MD, FACP, FSCT, FASCO, Chief Medical Officer and Executive Vice President of ASCO, said he doesn't know exactly how many trials have been delayed or suspended, but some major pharmaceutical companies have paused enrollment or clinical trials. In addition, Schilsky noted the National Cancer Institute has observed a 40 percent decline in sponsored trials.

"There's no doubt that clinical trials are being put on hold," Schilsky stated. "Patients are reluctant to access clinical trials at this time because it often entails more visits to the health care system. And many physical practices and hospitals dedicated to offering clinical trails to patients have chosen to delay or suspend enrollment in part because they have to redirect staff…to supporting critically ill patients with COVID-19 and cancer. It's going to take a while for all of this to recover, but we're optimistic that clinical trials will remain a critical element [to treating cancer]."

It's clear that COVID-19 will harm cancer care for months or potentially years, Burris said, but the virus is also taking a toll right now. In Italy, he cited a statistic that found that 20 percent of COVID-19-related deaths came in cancer patients. Burris also cited data from China: COVID-19 patients who have cancer are 5 times more likely to be put on a ventilator, which are often used as the last line of defense against the virus.

Even when patients aren't exposed to COVID-19, Burris noted that there are still challenges. Many hospitals, for example, are treating all cancer surgeries as elective surgeries, to be delayed until the virus dies down. Screenings are slowing down too, Burris said—there are usually 150,000 people diagnosed with cancer each month, but that number will be much lower for a while, as people fear going into health care and hospital systems for colonoscopies, mammograms, and other types of cancer screening.

Then there's the problem of scarce supplies. The entire health care system needs PPE and ventilators right now, but Burris noted that there's also a shortage of opiates to help treat the pain experienced by cancer patients. Schilsky said that the ongoing need for supplies and resources could be especially dire if a second wave of COVID-19 hits the country in the fall.

"Hopefully, the country will be much better prepared at that time for what the needs of the medical community are," he stated. "[The need for supplies] is not unique for cancer care providers but it's important to us."

Jonathan Marron, Chair-Elect of ASCO's Ethics Committee and Attending Physician of Pediatric Hematology/Oncology at Dana-Farber/Boston Children's Hospital, said on the call that the health care system is being stretched thinner than ever. There's a possibility that there will be greater demand for resources than there is a supply, he noted, and that puts oncologists in a nearly impossible position.

Marron said that ASCO wants to ensure medical resources are given out thoughtfully to ensure physicians aren't forced to provide care to a patient while also having to move resources away from that patient. He noted that ASCO recommends a cancer diagnosis alone shouldn't mean that a patient doesn't receive life-saving medical attention. However, cancer patients shouldn't get special treatment either, but ASCO recommends that oncologists are involved in making decisions about who gets health care resources. Oncologists shouldn't have to make decisions about their own patients, but health care systems should include them in gathering information and data on patients.

"ASCO hopes to ensure that oncologists are fully engaged in this process when possible," Marron noted. "Ultimately, we hope that these choices won't be necessary at all. We hope to ensure that patients with cancers can be reassured that resource allocation will be carried out with respect and evidence."

The ASCO released a set of policy recommendations to sustain quality cancer care amid and beyond the pandemic, Burris said. These include the following:

  • Better access to and support for telehealth, which allows patients to meet with doctors over video chat rather than needing to come into the office.
  • Adaptation of clinical trials, such as sending drugs to patients at their home, to ensure the trials can be salvaged.
  • Financial support for oncology practices.
  • Suspension of prior authorization.
  • Prevention of additional drug shortages. To this point, Burris said there will need to be "aggressive action" to mitigate any drug shortages.

Although the COVID-19 pandemic may seem dire for cancer care, Burris stated that he and others in ASCO see the pandemic as an opportunity to improve cancer care into the future. ASCO is currently forming two workgroups—one to deliver recommendation's on cancer care delivery and another to give recommendations for the future of cancer research.

"ASCO will stay closely engaged with policy makers in the months ahead," Burris emphasized.

Hal Conick is a contributing writer.