The global impact of the novel coronavirus cannot be overstated, but its effects on cancer care delivery in the United States have been particularly far-reaching. The COVID-19 pandemic has resulted in fewer cancer screenings and reduction in the treatment of new cancers. As a result, the National Cancer Institute (NCI) predicts about 10,000 excess deaths from colon and breast cancers alone over the next decade, according to Norman E. “Ned” Sharpless, MD, Director of the NCI.

“We make progress for patients with cancer through clinical trials, and we can’t afford to have those efforts delayed.”

— Norman E. ‘Ned’ Sharpless, MD

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“That’s about a 1% increase in excess deaths for those types of cancers,” said Dr. Sharpless in the second installment of “Chasing Cancer 2020,” a webinar series presented by The Washington Post Live and moderated by Frances Stead Sellers, a senior writer at The Washington Post. “Our initial assumptions about the disruptions to care from the pandemic were very conservative. In other words, the pandemic has actually provided more disruptions than [our models predicted].”

Delays in Cancer Screening and Treatment

For example, NCI modeling assumed a 75% reduction in the rates of colonoscopy and mammography, as well as an approximate 6-month delay in cancer treatment in the United States. However, the reality, he added, is beginning to look even more dire. Although screenings and treatments for certain malignancies can safely be delayed in the short term, for other patients, the risks associated with delaying treatment are far greater than the risk of contracting COVID-19, Dr. Sharpless noted.

According to Dr. Sharpless, the trends being seen in the delayed diagnosis and treatment of cancer will likely also play out in other non–cancer-related conditions, such as cardiovascular disease and neurodegenerative disorders. Additionally, hospitals have pressed pause on procedures deemed “elective,” although these procedures may actually be significant and medically necessary for many patients, further exacerbating the impact of the pandemic on health-care delivery.

Innovation, Innovation, Innovation

“We’ve made a lot of progress in cancer over the past few decades, and this year, we’re seeing a record number of new therapies make their way into clinical use,” said Dr. Sharpless. “However, the pandemic has provided a new challenge against that backdrop of progress.”

To prevent patients with cancer from suffering needlessly from the COVID-19 pandemic, physicians, researchers, and caregivers must take collective action, he added, and that starts with making innovations to the provision of care. “We’re moving toward telehealth, being clever about how we do clinical trials, and incorporating new modalities for therapy earlier and at different stages,” Dr. Sharpless continued. “Through research, science, and collective action, we can mitigate the impact of the coronavirus pandemic on patients with cancer.”

Turning Toward Telehealth

According to Dr. Sharpless, if there is a silver lining to this pandemic, it would be the recognition of telemedicine’s indisputable benefits in the delivery of cancer care. “Overnight, doctors in all specialties, including oncology, have been given the ability to conduct telemedicine visits for a variety of clinical situations,” he said. “And it’s been widely embraced, because we’ve had to embrace it.”

Dr. Sharpless credits the medical community for its ingenuity in providing telemedicine to patients in ways not seen or even imagined before. For example, a number of oncology clinical trials of novel therapeutics have been moved into the telemedicine space. “Patients can talk to their doctor about a new therapy, consent to the trial by phone, and then the drugs are mailed to them, without actually having to leave their home,” he explained. “So, we can effectively do something complex and challenging, like enrollment in a clinical trial, through telehealth.”

Although telehealth may have altered the landscape of care delivery, the reality remains that procedures such as mammography, colonoscopy, and chemotherapy infusions cannot be delivered virtually. “I believe telemedicine is here to stay,” commented Dr. Sharpless. “I don’t think our patients are going to want to go back to the era when they had to see their doctor for everything, but we’re still going to need doctors’ visits, and we have to be innovative in solving that problem, too.”

Impact on Clinical Trials

According to Dr. Sharpless, oncology clinical trials have been slowed down by the pandemic, but the current focus on COVID-19 vaccine trials is not to blame. At the beginning of the pandemic, accrual for NCI therapeutic clinical trials was down about 50%. “They’ve now recovered somewhat,” he noted, “but we’re still down substantially from our usual accrual rates.” He added that nontherapeutic trials (ie, screening and quality-of-life trials) have been even more adversely affected, and accrual for these trials has dropped more significantly than for therapeutic trials.

“The clinical trials engine has been compromised severely by the coronavirus, and we have been trying to work flexibly with the FDA and our investigators to provide means to resume clinical trials activity, despite the pandemic,” Dr. Sharpless reported. “We’re having some success, but we still need to build that capacity. We make progress for patients with cancer through clinical trials, and we can’t afford to have those efforts delayed.”

Although the United States has long been praised for making great strides in personalized medicine and targeted therapies for patients with cancer, it has also been criticized for its lack of investment in public health. According to Dr. Sharpless, the COVID-19 pandemic has only served to illuminate this dichotomy, making it abundantly clear that changes must be made, and soon.

“I’ve learned in my work at the NCI and the FDA that you cannot go it alone with just therapy of disease. One needs preventive public health approaches that are robust and well organized, and no doubt the current pandemic has provided serious public health challenges for our country and every other nation,” Dr. Sharpless explained. “We have to diagnose and prevent disease in a way that is nimble and can meet unexpected challenges in the future.” 

This webinar was sponsored by Pfizer and presented on The Washington Post Live on July 16, 2020. For full disclosures for Dr. Sharpless, see related article.