Report on COVID-19 Outlines the Pandemic’s Negative Impact on Patient Care and Clinical Research—and the Lessons Learned

Patients with cancer are not only at an increased risk for developing severe COVID-19, but also face cancer treatment delays and interruptions due to the pandemic, potentially worsening cancer outcomes, according to the AACR Report on the Impact of COVID-19 on Cancer Research and Patient Care. In addition, the report from the American Association for Cancer Research (AACR) finds the pandemic has caused significant challenges for researchers and has led to laboratory closures and clinical trial interruptions.¹

The report was released on February 9 during a virtual Congressional briefing. It documents both the challenges caused by the pandemic and the lessons learned that can lead to improvements in clinical trial design and patient care.

Consequences for Patients With Cancer

Patients with cancer, especially those with hematologic cancers, not only face a greater chance of contracting COVID-19 and having severe illness, but interruptions in their cancer treatment may also contribute to worse cancer-related outcomes in the coming years. According to the report:

• Patients with hematologic cancers, as well as those receiving B-cell–targeted therapeutics, are at higher risk for being infected with the coronavirus and have also been shown to have a poor response to the available vaccines.
• The delays in cancer screening, diagnosis, and treatment caused by the pandemic have had and may continue to have negative effects on cancer outcomes.
• Racial and ethnic minorities and other medically underserved populations have shouldered a disproportionate burden of COVID-19 and have been more affected by pandemic-related disruptions to the cancer care continuum.

The pandemic has resulted in nearly 10 million missed cancer screenings from January to July 2020. It also has:

• Impaired referrals for preliminary cancer diagnoses led to an 11% increase in patients diagnosed with inoperable or metastatic cancer during March to December 2020 compared with the same time frame in 2019.
• Caused delays in cancer treatments, including chemotherapy, immunotherapy, radiotherapy, and surgery.
• Impacted the mental health of patients, survivors, and caregivers due to social isolation, financial stress, food insecurity, and concerns about timely access to cancer treatments and disease recurrence.

Challenges Faced by Researchers—and the Rewards

The pandemic has not only upended scientific research and clinical trial investigations; it has also negatively impacted the career development of researchers, especially for women and other minorities. According to the survey results published in the report of 66 AACR grant recipients:

• 99% of respondents said the pandemic negatively impacted their research, career, and/or patient care.
• 87% reported a loss in productivity.
• 61% said the pandemic has delayed their career advancement.

However, the results from the survey also show that researchers used their expertise in genetics, immunology, and drug development to combat the pandemic. For example, the report details how the National Cancer Institute (NCI) unified its national network of serology centers to support research on SARS–CoV-2 immunology and to increase the nation’s serologic testing capacity, resulting in new insights into the mechanisms of immune response to COVID-19.

In addition, decades of research in mRNA vaccines for use as cancer immunotherapies was instrumental in the quick development of COVID-19 vaccines and has renewed enthusiasm for continued investigation in mRNA-based cancer immunotherapies.

Antoni Ribas, MD, PhD, FAACR

“We have tackled cancer in a science-based manner, where we define the problem, understand the processes, and then develop treatments or ways to improve health,” said Immediate Past-President of AACR, Antoni Ribas, MD, PhD, FAACR, Chair of both the AACR Report on the Impact of COVID-19 on Cancer Research and Patient Care Steering Committee and the AACR COVID-19 and Cancer Task Force, in a statement. “The same had to be done for COVID-19. The cancer research community has generated so many tools to study cancer—sequencing, developing antibodies, pioneering targeted therapies—that have also helped researchers address COVID-19. And the best example of all is the COVID-19 mRNA vaccines.”

Improving Cancer Care

Despite the many disruptions in cancer care and clinical research caused by the pandemic, COVID-19 helped usher in some practices that may lead to future improvements in cancer care for patients, according to the report. For example, the use of telemedicine jumped 38 times higher in July 2021 than before the pandemic. The pandemic also amplified barriers to clinical trial participation; in response, the U.S. Food and Drug Administration (FDA) outlined voluntary flexibilities for clinical trials, including using telemedicine to assess patient outcomes and wellness as well as allowing home delivery of trial medications, remote consenting, and collaborations with local clinics, imaging facilities, and laboratories.

The AACR report includes steps Congress should take to rebuild the country’s public health infrastructure, enhance medical research, and modernize how patients receive care and enroll in clinical trials. The recommendations include the following:

• Offsetting pandemic-related research costs by providing at least $10 billion for the National Institutes of Health (NIH) and its grantees in emergency supplemental funding as proposed in the Research Investments to Spark the Economy (RISE) Act of 2021.²
• Increasing investments in cancer research and prevention by supporting robust, sustained, and predicable growth for the NIH and NCI, including at least $3.5 billion and $1.1 billion, respectively, in fiscal year (FY) 2022, for a total funding level of $46.4 billion for NIH and $7.6 billion for NCI.
• Enacting policies that broaden health-care coverage and reduce inequities in access to health care, such as expanding Medicaid
• Delivering a permanent extension of the Centers for Medicare & Medicaid Services–approved telehealth services and supporting greater access to telehealth by providing funding, including grants, to support highspeed broadband, reach underserved areas, and address the digital divide
• Supporting the FDA’s regulatory science initiatives and advancing the development of oncology products by providing an increase of at least $343 million in discretionary budget authority in FY 2022
• Increasing diversity in clinical trials and alleviating the financial burden on prospective trial participants by reimbursing patients for ancillary trial-related costs, including transportation and lodging, as contained in the Diversifying Investigations Via Equitable Research Studies for Everyone (DIVERSE) Trials Act.³

“The COVID-19 pandemic has highlighted the importance of basic science, cancer prevention, cancer screenings, and addressing cancer disparities,” said Margaret Foti, PhD, MD (hc), Chief Executive Officer of AACR, in a statement.

Margaret Foti, PhD, MD (hc)

“To restore the momentum against cancer, we urge Congress to continue its long-standing commitment to supporting cancer research. Robust, sustained, and predictable annual funding increases for NIH and NCI will propel future scientific advances, maximize returns from prior investments in cancer research, drive economic prosperity, and support new lifesaving cures for patients with cancer.” 

DISCLOSURE: Dr. Ribas reported relationships with Agilent, Amgen, Bristol Myers Squibb, Chugai, Genentech, Merck, Novartis, Roche, Sanofi, Vedanta, Advaxis, Apricity, Arcus, Compugen, CytomX, Five Prime, Kite/Gilead, Lutris, Merus, Rgenix, and Tango Therapeutics. Dr. Foti is Chief Executive Officer of the AACR.

REFERENCES

1. American Association for Cancer Research: AACR Report on the Impact of COVID-19 on Cancer Research and Patient Care. Available at www.aacr.org/professionals/research/aacr-report-on-covid-19-and-research. Accessed February 14, 2022.

2. Congress.Gov: H.R. 869-RISE Act of 2021. Available at www.congress.gov/bill/117th-congress/house-bill/869?s=1&r=67. Accessed February 14, 2022.

3. Congress.Gov: S.2706—DIVERSE Trials Act. Available at www.congress.gov/bill/117th-congress/senate-bill/2706?s=1&r=39. Accessed February 14, 2022.