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Published on December 28, 2020
How has COVID-19 Impacted the State of Cancer Care?
Nine months after the outbreak of the novel coronavirus resulted in the disruption of routine cancer screenings, treatments and clinical trials, the National Cancer Institute (NCI) has assessed the pandemic’s overall impact on cancer. NCI Director Dr. Norman Sharpless said the agency has calculated 10,000 excess deaths due to colon and breast cancer because of disruptions in care.
“We now have since come to believe that this estimate is very conservative,” Dr. Sharpless said in a plenary session at the 2020 San Antonio Breast Cancer Symposium (SABCS) held earlier this month. “Additionally, there is nothing about this modeling that is unique to breast and colon cancer. We think excess deaths in other kinds of cancer, like lung cancer, will also be caused by the pandemic for many of the same reasons.”
During his 30-minute address, Dr. Sharpless noted there has been a marked reduction in cancer screening and diagnosis. He said a 50% decrease in new diagnoses is particularly “worrisome,” since there is no reason to believe the incidence of cancer has declined by that much. “I believe these cancers, many of them, will become obvious in just a few months — at later stage and also worse prognosis,” he said. “While no doubt some of the diagnosed cancers that we’re not detecting now are indolent, and the delay may not be problematic, it’s certainly not 50% of cancers, and we are seeing decreased diagnoses of cancers like lung cancer and pancreatic cancer where indolent disease is very rare.”
COVID-19 and Clinical Trials
Dr. Sharpless also spoke about the impact of the pandemic on clinical trials. Before the pandemic, about 300 patients a week were accrued to the NCI’s largest trials, according to data from the NCI’s National Clinical Trials Network. By April that had been cut in half, but it has slowly recovered. “These trials will take longer to finish, longer to report out and therefore, longer to be of benefit to patients,” Dr. Sharpless explained. He said accrual in industry-sponsored trials is as bad or worse than what is seen in NCI. “We want to try to minimize the impact to patients and catch up as much as possible.”
He noted accrual in the NCI’s TMIST breast screening trial was already less than what the NCI had hoped, and it has been made substantially worse by the pandemic. The trial compares two types of FDA-approved digital mammography: standard digital mammography (2-D) and tomosynthesis mammography (3-D). The goal of the trial is to help researchers learn the best ways to detect breast cancer in women who have no symptoms.
The NCI worked with the FDA to ensure clinical trials were able to continue if possible. Changes included mailing oral medication to patients’ homes, transitioning patients to receive care at sites closer to home to minimize travel and exposure, and allowing telehealth appointments so patients and healthcare providers could connect via phone or the internet rather than in person.
“Patients really liked many of these changes and the clinical trialists have as well,” he said. “And I think some of these changes that have been forced upon us by the pandemic are going to be positive changes that we are going to want to keep even after the coronavirus goes away because they benefit patients, and they make accrual to clinical trials simpler in many cases.”
Dr. Sharpless highlighted several NCI-funded studies, including two exploring health disparities in breast cancer research. Details of three of them are below:
- The “exceptional responders” study is a comprehensive analysis of patients with cancer who had an exceptional response to therapy. For 26 of 111 patients (24%), researchers were able to identify molecular features that could potentially explain the exceptional response to treatment, such as the co-occurrence of multiple rare genetic changes in the tumor genome or the infiltration of the tumor with certain types of immune cells.
- The Breast Cancer Genetic Study in African-Ancestry Populations initiative is a study that will look at the genomes of 20,000 Black women with breast cancer and compare them with 20,000 Black women who do not have breast cancer.
- The Detroit Research on Cancer Survivors (ROCS) study will investigate the myriad of factors that may affect cancer survival among African Americans, including type of treatment, poverty, stress, racial discrimination and behavioral factors such as smoking, alcohol use, diet and physical activity.
The changes forced upon health care providers, researchers and patients come as the United States approaches the 50th anniversary of the National Cancer Act of 1971. The bill signed by President Richard Nixon created the nation’s clinical trial network, established NCI-designated cancer centers, and accelerated research on prevention, screening, diagnosis and research, among other things.
“One can’t promise an end to cancer,” Dr. Sharpless said. “One can’t promise a future cure for cancer. What we believe we can promise to our stakeholders is that nothing will stop us. We will work as hard as possible for as long as it takes to reduce cancer suffering and we will never stop trying.”
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