AACR Report Sheds Light on COVID-19 Impact on Cancer Research and Care

A first-of-its kind report from the American Association for Cancer Research (AACR) detailed the impact of the COVID-19 pandemic on cancer care and research, plus how practices have evolved to overcome challenges.¹

In general, several populations are at an increased risk of developing severe COVID-19, such as those with underlying conditions like cancer and racial/ethnic minority populations that are known to be underserved.² In particular, patients undergoing treatment with B-cell targeting therapeutics or with hematologic malignancies or lung cancer are considered to be the most vulnerable if infected. Although many patients mount a good immune response following COVID-19 vaccination, patients with hematologic malignancies and/or patients being treated with B-cell depleting therapies often have suboptimal responses to vaccination.

Aside from delaying services such as routine screenings and necessitating treatment modifications, the pandemic had a significant impact on referrals for preliminary cancer diagnoses and resulted in an increase in patients with inoperable and metastatic disease. Due to this, experts in the field are concerned that an increase in cancer morbidity and mortality make take place over the next few years. The pandemic has also notably impacted clinical cancer research, with 99% of cancer investigators surveyed by the AACR (n = 66) indicating that COVID-19 has impacted research and/or clinical practice.

Overcoming Challenges in Cancer From the Pandemic

To refocus their efforts during the pandemic, investigators in the cancer space used their knowledge of genetics, epigenetics, immunology, drug development, and technologies such as next-generation sequencing to investigate COVID-19 biology and treatments.³ Another focus was short- and long-term monitoring of the impact of the pandemic on patients with cancer. Investigators are accumulating clinical and patient-related data on a large scale to assess the epidemiology of COVID-19 in patients with cancer. Other areas of research include the efficacy of COVID-19 diagnostics, vaccines, and treatments. Numerous initiatives have been launched across several organizations and institutions to spark data sharing.

The Future of Telemedicine in Cancer

Although the pandemic initially presented challenges, adaptations were implemented that minimized the impact of COVID-19 in the cancer space and may provide insights for cancer science and medicine.⁴ To rise to the challenges of the pandemic, clinical trial investigators needed to implement patient-centric adjustments to clinical trials to provide necessary care to patients. As of July 2021, telehealth use had increased 38-fold compared with before the pandemic. Moreover, 43% of patients stated that they wanted to continue using telehealth to fulfill their health care needs after the pandemic. Although the benefits are apparent, telehealth policies adopted during the lockdown phase of the pandemic need to become permanent to allowed for long-term use and more widescale implementation.

Findings from a nationwide public opinion poll conducted from March 26, 2021, to April 5, 2021, indicated that that most Americans were in favor of a telehealth expansion. Forty-five percent of patients with cancer stated their preference for a telemedicine visit vs 34% who preferred a visit in office. Patients stated that a reduction in travel time (42%) and decreased risk of COVID-19 infection (37%) were some of the most prominent reasons for feeling satisfied with telehealth. Patients with cancer who were born from 1981 to 1995 were more likely to be satisfied with access to telemedicine (87%) vs patients who were born from 1928 to 1945 (72%). Most patients had an initial visit for genetic services (80%) and most (96%), including patients with hereditary malignancies, stated that genetic counseling they received through telehealth was of good quality. In April 2020, 34% of Hispanic patients used video-based telehealth services vs 51% of Asian patients. In March 2020 to December 2020, 54% of non-Hispanic White patients with cancer used telehealth compared with 38% of Black patients.

Investigators also believe that telemedicine can be used to provide palliative care, such as exercise-based interventions, for patients who have survived cancer. A study assessed adherence to an online exercise-based intervention for survivors of prostate cancer and their spouses and found that participation increased from 81% to 91%. Additionally, retention increased from 84% to 92% between in-person and online mediums, respectively, with similar findings reported for patients with breast cancer. Additionally, it is theorized that telemedicine may even work to reduce phyisicna burnout within the oncology space, with ongoing research efforts dedicated to answering this question.

As the pandemic has made participation in clinical trials more difficult, the FDA detailed voluntary flexibilities for clinical cancer research in March 2020.⁵ Some of these include the use of telemedicine to examine patient outcomes, medication home delivery, and remote consenting as well as collaboration with local clinics, imaging facilities, and laboratories. Should the modification be implemented permanently, clinical trial costs could decrease and better allow patients to enroll. The FDA and National Cancer Institute will cooperate with other stakeholders to determine which modifications are important enough keep.

Examining Racial and Ethnic Equity in Cancer

In terms of other updates, the FDA stated that increased participation of racial and ethnic minorities and other underserved individuals in the medical community has been a priority throughout the pandemic. As such, Project Equity was launched in 2020 by the FDA Oncology Center of Excellence, which aimed to improve the evidence base for underrepresented groups through guidance for trial recruitment, stakeholder collaboration, and outcome analysis. Moreover, voluntary guidelines were released in November 2020 by the FDA Center for Drug Evaluation and Research and the Center for Biologic Evaluation and Research with the goal of increasing diverse clinical trial participation.

Some of the guidelines include expanding clinical trial eligibility criteria, creating strategies to recruit a patient pool reflective of real-life patient diversity, and supporting trial sponsors to determine safety and efficacy of investigation drugs in racial and ethnic minority populations. Two other guidelines include maintaining the quality of data and patient safety when partnering with local facilities for decentralized trials and utilizing real-world evidence to determine when clinical data feasibility is limited.

In a call to action, the AACR stated that congress should support the FDA’s “initiatives to improve the drug development and review process by increasing the discretionary budget authority by at least $343 million in FY 2022.” The call to action also appealed to Congress’ support for increasing diversity in clinical research by passing the Diversifying Investigations Via Equitable Research Studies for Everyone (DIVERSE) Trials Act.⁶ The goal of the DIVERSE Act is to both increase diverse clinical trial participation and relieve financial burden on potential trial participants by reimbursing individuals for ancillary costs related to the clinical trial such as transportation and lodgings.

References

1. AACR releases report outlining impact of COVID-19 pandemic on cancer Research and patient care. News release. American Association for Cancer Research. February 9, 2022. Accessed February 10, 2022. https://bit.ly/3GJ19o1
2. A snapshot of the impact of the COVID-19 pandemic on cancer research and patient care. American Association for Cancer Research. Accessed February 10, 2022. https://bit.ly/35YkCnX
3. Cancer researchers working to combat the COVID-19 pandemic. American Association for Cancer Research. Accessed February 10, 2022. https://bit.ly/3svwntM
4. Future of cancer science and medicine beyond COVID-19. American Association for Cancer Research. Accessed February 10, 2022. https://bit.ly/3gANRPN
5. Policies to combat the impact of a global health crisis on cancer science and medicine. American Association for Cancer Research. Accessed February 10, 2022. https://bit.ly/3HLJnle
6. The AACR call to action. American Association for Cancer Research. Accessed February 10, 2022. https://bit.ly/34OcpSC