Research Snippet #5: The Effect of COVID-19 on the Field of Oncology
CSM research review returns in 2021
Introduction
The 11th of March marked the one year anniversary since the WHO declared COVID-19 a global pandemic. More than one year in, this global event has impacted many disciplines – and the field of oncology is no exception. It has affected many cancer services including cancer screening and diagnostics, cancer research and clinical care, and cancer patient care. These aspects are all cornerstones of cancer treatment and cancer prevention. Whilst we have seen a lot of disruption, there are still many lessons to be learnt from this pandemic including those for improving cancer care to patients globally.
Figure 1 The Effect of COVID-19 on Cancer care, Research and Funding
Taken from: [1]. Bakouny Z, Hawley J, Choueiri T, Peters S, Rini B, Warner J et al. COVID-19 and Cancer: Current Challenges and Perspectives. Cancer Cell. 2020;38(5):629-646.
The COVID-19 pandemic has had a far-reaching impact on both patients’ health-seeking behaviour. One of the earliest tolls of COVID-19, was a significant drop in engagement with cancer screening. A Cancer Council of Australia report showed that in the first half of 2020, there were 144,982 fewer mammograms, 443,935 fewer cervical screens, and 144,379 fewer mail-out bowel screening tests conducted, compared to previous years [1]. How can we understand this statistic? In the early stages of the pandemic, many Health Services temporarily halted screening services due to the perceived “non-urgent nature” of screening, or to divert resources in anticipation of a surge in COVID-19 patients. Indeed, this had a sizable impact on screening. But despite many screening programs resuming operation in the months since, the screening rate is yet to be restored to pre-pandemic numbers. This disparity is reflective of an arguably greater barrier for cancer screening – patient reluctance to physically attend GP practices or hospitals. The underlying reasons are manifold. Foremost, a fear of COVID-19 transmission; which is particularly a concern for people of elderly age or living with co-morbidities. But other reasons include delaying of routine/proactive check-ups or hospital visits due to perceived inconvenience of COVID-19-related precautions, or in some cases an altruistic effort to not burden the COVID-19-impacted healthcare system further. A study from the UK showed that during the country’s first COVID-19 wave, almost half of those who experienced potential cancer symptoms such as sudden and inadvertent weight loss, coughing up blood, or emergent lumps, chose to delay visiting a doctor [2].
The natural consequence of such delays in cancer screening/check-ups, is that we miss the small window of opportunity for early-disease detection. As a result, many cancers which are amenable to early intervention if detected early will instead present at a later stage when they are pathologically more advanced. This potentially restricts treatment options and limits patient survival prognosis [3]. Yet, we are only in the immediate throws of COVID-19, and the pandemic is not yet ended. Cancers are known for their insidious nature, and many experts predict that we won’t truly know how much damage the pandemic has done to the rates of cancer detection and management, until many years down the road. As VCCN co-Chair Grant McArthur so aptly states… ”COVID-19 has not changed the fact that 1 in 3 men and 1 in 4 women will be diagnosed with cancer by the age of 75” [4]. Indeed, Cancer Council Victoria chief executive Todd Harper anticipates a “spike in [late-stage] cancer cases in the coming months” [5].
Approach to Cancer Screening Adapting during COVID-19
Whilst COVID-19 has exposed many challenges and deficits in the healthcare system, it has also been a great catalyst for advances in the way we deliver and implement cancer screening services.
One such example of this is The National Cervical Screening Program (NCSP). NCSP has faced many challenges in recruiting under-screened women for cervical cancer during COVID-19 due to the need to attend clinics. Ongoing attendance at clinics and monitoring is important for all cancers, but in particular for cervical cancers, as these results can allow physicians to detect abnormal cytology and premalignant cells before they progress. The NCSP was able to adapt to these challenges by offering self-administered kits to underscreened women aided by telehealth services for any support that was required [6]. Furthermore, targeted media campaigns were designed to encourage women to take up and utilise these kits.
Overall, this pandemic has not only highlighted the importance of adaptability for all services but also the need to future proof our essential services to ensure that they are able to continually deliver care.
Impact of COVID-19 on Cancer Research & Clinical Trials
Cancer care and clinical trials have experienced substantial challenges and interruptions during the pandemic. There have been significant suspensions to trial recruitment and study protocols involving: mandated clinic visits, routine scans, biopsies and blood tests. Collectively, this has affected trial endpoints which have impacted patient safety, and have delayed both effective treatment production and drug development [7]. Due to these disruptions, it is predicted that a delay in cancer surgeries or treatment of approximately 6 months will result in a reduction of life-years-gained from 18.1 to 15.9 [7].
COVID-19 has also provided key lessons for the field of oncology to learn. If we can apply the same rigour for COVID-19 clinical trials to that of clinical cancer research, it is possible to substantially decrease “the time, regulatory, and administrative costs involved in coordinating, registering, and conducting trials overall” [7]. However, this is not to say that standards of clinical trials, such as peer review, are lowered through this rapid dissemination of clinical trials. Instead, both transparency of data sources and reproducibility of any methodology are components that remain necessary [7].
Telehealth and Cancer Research
The pandemic has strengthened the use of telehealth services, especially in times of quarantine and isolation. This use of telehealth and video-conferencing technology can be helpful for remote monitoring of the clinical visits and other necessary study protocols. Via telehealth, there can also be a reduction in patient-hospital contact, which can improve cancer care and the quality of health for the immune-compromised patients [7]. With the same mentality, cancer clinical trials can implement remote study hubs, when safe and efficacious, to improve recruitment, site visits and also minimise patient contact [7].
Concluding Statement and Future Remarks
Overall, whilst COVID-19 has tested many aspects of our healthcare system, it has also provided us with many lessons to learn from. Indeed, these turbulent times have shown not only the faults in our cancer delivery services but also underscored the adaptability and resilience of our healthcare system.
References
[1]: Australian Institute of Health and Welfare 2018. Analysis of cancer outcomes and screening behaviour for national cancer screening programs in Australia. Cancer series no. 111. Cat. no. CAN 115. Canberra: AIHW.
[2]: Quinn-Scoggins H, Gjini A, Brain K. The Impact of COVID-19 on Cancer Symptom Experience and Help-Seeking Behaviour in the United Kingdom: A Cross-Sectional Population Survey. The Lancet. 2021;.
[3]: P Hanna T, Sullivan R, Aggarwal A. Mortality due to cancer treatment delay: systematic review and meta-analysis. BMJ. 2020;371(8269).
[4]: Liotta M. newsGP – Breast cancer awareness should not stop for a pandemic [Internet]. NewsGP. 2020 [cited 9 April 2021]. Available from: https://www1.racgp.org.au/newsgp/clinical/breast-cancer-awareness-should-not-stop-for-a-pand
[5]: Boseley M. Fears late cancer diagnoses in Victoria because of Covid could cause fatal spike [Internet]. 2021 [cited 9 April 2021]. Available from: https://www.theguardian.com/australia-news/2021/mar/01/fears-late-cancer-diagnoses-in-victoria-because-of-covid-could-cause-fatal-spike
[6]: Australia C. Review of the impact of COVID-19 on medical services and procedures in Australia utilising MBS data: Skin, breast and colorectal cancers, and telehealth services [Internet]. Review of the impact of COVID-19 on medical services and procedures in Australia utilising MBS data: Skin, breast and colorectal cancers, and telehealth services | Cancer Australia. Cancer Austraila; 2020 [cited 2021Apr25]. Available from: https://www.canceraustralia.gov.au/publications-and-resources/cancer-australia-publications/review-impact-covid-19-medical-services-and-procedures-australia-utilising-mbs-data-skin-breast-and
[7]: Bailey C, Black JRM, Swanton C. Cancer Research: The Lessons to Learn from COVID-19. Cancer Discovery. 2020Jul15;10(9):1263–6.
