On December 8, ASCO issued comprehensive recommendations to guide the cancer community’s eventual recovery from the COVID-19 pandemic. By applying lessons learned during the pandemic, ASCO’s Road to Recovery Report: Learning From the COVID-19 Experience to Improve Clinical Research and Cancer Care intends to make cancer care and research opportunities more accessible to and equitable for patients in every community. Of note, ASCO aims, with its recommendations, to address long-standing cancer care disparities that have been highlighted by the pandemic.
“When the pandemic is over, patients deserve more than a return to the way things were before COVID-19. We have an opportunity to provide better care to everyone with cancer drawing from the insights we’ve gained during the pandemic,” said ASCO President Lori J. Pierce, MD, FASTRO, FASCO. “Cancer care is marked by the same inequities as our society at large. To emerge from the pandemic stronger, we have to make sure every patient can benefit from advances in cancer research and care.
Lori J. Pierce, MD, FASTRO, FASCO
To develop the recommendations, ASCO established volunteer task forces focusing on cancer care delivery and cancer research. Comprising ASCO member physicians and other cancer care professionals and patient advocates, the task forces evaluated responses to COVID-19 made by federal and state governments, health plans, providers, and others to understand the impact of the pandemic on cancer care and research. Based on this assessment and lessons learned, the task forces highlighted opportunities to strengthen both the cancer care delivery system and cancer clinical trials beyond the pandemic. Their recommendations, approved by ASCO’s Board of Directors, were published earlier this month in ASCO’s Journal of Clinical Oncology.
Changes to Cancer Care and Research
The ASCO report details how the COVID-19 pandemic has put significant pressure on the cancer care system. Providers and researchers have had to adapt quickly—often with coordination or support from policymakers and payers—to minimize disruptions to patients’ care. To date, most patients who were already in treatment have continued to receive care, thanks to the swift expansion of telemedicine, implementation of new COVID-19 safety protocols, and other steps to prevent COVID-19 exposure. Similarly, patients already enrolled in clinical trials have largely been able to continue their participation.
Newly diagnosed patients, however, have sometimes faced delays in starting care. Depending on the status of the pandemic in an area, for example, many hospitals, states, and local governments postponed cancer surgeries. COVID-19 has also caused massive disruptions to clinical trial enrollment and the launch of new trials. These disruptions have prevented patients from receiving promising new therapies and will likely delay future advances. There are also significant concerns about delays in recommended cancer screenings.
“To a remarkable degree, we’ve weathered the pandemic with manageable disruptions to the care of existing patients,” said ASCO immediate past president Howard A. “Skip” Burris, MD, FACP, FASCO, who oversaw the task forces’ work. “But for newly diagnosed patients or those seeking clinical trials, it’s been an especially difficult period. We owe it to patients to act on what we’ve learned, and to better support them now and after the pandemic has receded.”
Howard A. “Skip” Burris, MD, FACP, FASCO
Recommendations Span Most Aspects of Cancer Care
ASCO’s comprehensive recommendations fall into two broad categories: cancer care delivery and clinical cancer research. Some are directed at specific bodies, such as Congress or the Centers for Medicare & Medicaid Services, whereas others require action from a combination of stakeholders, including ASCO. Highlights of the recommendations follow:
Clinical Cancer Research
ASCO calls on research institutions, trial sponsors, and regulators to make the clinical trials system more resilient and flexible, and more accessible to patients. Specifically:
Increase patient access and equity—by continuing remote and virtual approaches to consent agreements and other trial procedures; and by better integrating trials into routine cancer care
Increase trial efficiency— by streamlining and standardizing regulatory and training requirements; and using central institutional review boards and innovative trial designs (including adaptive trials, master protocols, and common control groups)
Increase flexibility so research will be more resilient in future crises—for example, by “cross training” research teams so key functions can be led by various team members; and by sustaining flexibility, adopted during the pandemic, for site selection, initiation, and data collection.
Cancer Care Delivery
ASCO calls on policymakers, payers, clinicians, and others to build on strategies that have helped to meet patients’ most urgent needs in the worst of the pandemic. Specifically:
Increase access to and equity of care—by making expanded coverage for telemedicine permanent; preventing Medicaid cuts; ensuring accessible, affordable and comprehensive insurance plans, and preventing other threats to patients’ health coverage; enhancing grants and other support for oncology practices in underserved communities; and sustaining federal safety net programs
Protect patient safety—for example, by creating new chemotherapy infection control standards that account for viral threats like the novel coronavirus; ensuring reliable access to personal protective equipment and future COVID vaccines; and limiting home infusion of potentially risky chemotherapy to exceptional circumstances
Support patient and provider well-Being—by expanding access to behavioral health care and psychosocial support for patients; and enhancing training and support for care teams, which have been disrupted by staffing changes and burnout in the face of the pandemic.
Advocacy, Research, and Practice Support
To drive implementation of the recommendations, ASCO and its affiliated organization, the Association for Clinical Oncology, will pursue a range of new and expanded initiatives. On the advocacy front, the Association for Clinical Oncology will continue to press for policies that enhance patient access to and equity of care, including clinical research. To expand and enhance the evidence base for recent adaptations, such as expanded telemedicine, ASCO will release findings from its ASCO Survey on COVID-19 in Oncology (ASCO) Registry; conduct new research; deliver new guidance to clinicians and researchers; and assess the impact of that guidance on patient care over time.
For months, cancer care providers have been navigating uncharted territory without sufficient evidence or resources,” said Dr. Burris. “ASCO is doing everything we can to close gaps in knowledge and information, and we urge Congress, the Administration, and the entire cancer community to step up so that we recover from this pandemic with a stronger, more equitable cancer care system.”