On February 27, 2020, the Journal of Thoracic Oncology published a case study that described two patients from Wuhan, China, who had recently underwent lung lobectomies for adenocarcinoma and were retrospectively found to have had COVID-19 at the time of surgery. Eleven months later, the lung cancer research community gathered virtually—due to the pandemic—at the International Association for the Study of Lung Cancer (IASLC) 2020 World Conference on Lung Cancer (WCLC) Singapore. In a press briefing during the meeting, investigators shared a number of research findings examining the intersection of COVID-19 and lung cancer.
The press briefing was moderated by IASLC President-Elect Heather Wakelee, MD, FASCO, Chief of the Division of Medical Oncology at Stanford University and Deputy Director of the Stanford Cancer Institute. Patient Advocate and lung cancer survivor Ivy Elkins, MBA, Co-Founder of the EGFR Resisters and a member of the IASLC Lung Cancer News Editorial Group, contributed insights from the advocacy community's perspective.
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Mental Health Impact
The fear of contracting COVID-19 among patients with lung cancer is palpable, and three new research studies underscored how vulnerable patients with lung cancer feel as they cope with the pandemic.
Domenico Galetta, MD, PhD, of the Medical Thoracic Oncology Unit of IRCCS Oncology Institute of BARI Italy, examined 176 patients with lung and breast cancers, as well as lymphoma, for signs of psychological distress caused by COVID-19 and the lockdown measures necessitated by the pandemic. His team found that about one-quarter of patients reported severe symptoms of posttraumatic stress disorder (PTSD), with females presenting higher levels when compared with males (Featured Poster, FP06.04).
“Patients with lung cancer have higher distress compared to the other groups. This condition risks being overlooked by clinical concerns, so we underline the importance [in our abstract] to place even more attention on the psychological needs of patients,” said Dr. Galetta.
Another study conducted by the Chicago-based LUNGevity Foundation (Abstract MA07.08) echoed these findings. The group surveyed 302 patients with lung cancer about anxiety regarding access to lung cancer care, patient preparedness to navigate care, and information needs during the COVID-19 pandemic. Overall, 96% of respondents were concerned that the pandemic would affect their cancer care, and 46% reported interruption in lung cancer care, including not being able to see their doctor. Another 18% said they experienced increased difficulty in receiving appropriate care, and 45% of respondents worry about accessing care postpandemic.
“Our study reveals that patients with lung cancer continue to feel vulnerable and ill-equipped to navigate cancer care post shelter-in-place. Indeed, patient-specific factors (treatment status) and local COVID-19 caseload are important predictors of patient worries. Access to health-care should be taken into account both during patient-physician discussions and during lung cancer care planning at a systems level,” according to Jessica Selig, of the LUNGevity Foundation.
Importance of Support Organizations
At a time when patients are in more need of support services, including mental health support, organizations that provide these services report their resources have been negatively affected during the pandemic.
The Global Lung Cancer Coalition (GLCC) is a partnership of 40 patient organizations across 29 countries, dedicated to improving outcomes for patients with lung cancer. The GLCC conducted a survey of its members and found that 64% receive more requests from patients with lung cancer as compared with before the pandemic, but 67% had closed or discontinued services such as support groups and seminars (Abstract MA07.07). GLCC found that 18% of organizations surveyed added new programs such as new digital services (including calls to patients and online consultations), extending helpline hours, and adding new online content.
“Patient advocacy and support organizations are providing more support to patients during the pandemic. However, many organizations have seen a decrease in funding, making it more challenging to [continue or increase support programs]. Patient organizations need urgent financial support to continue to meet increased patient needs and, for some, to survive,” said Matthew Peters, MD, of Concord Hospital, Concord, Australia.
Pandemic’s Effect Access to Lung Cancer Care or Diagnosis
A study conducted by a group led by Roxana Reyes, MD, of the Hospital Clínic de Barcelona, Thoracic Oncology Group, Barcelona, collected data of new cases of lung cancer diagnosed in two periods—during the COVID-19 pandemic and the same period in 2019—and found a 38% decrease in the number of new cases diagnosed during the COVID-19 pandemic (Abstract MA03.08).
Of those, researchers found that in the group of patients with NSCLC, there were more instances of symptomatic and severe disease at diagnosis in the 2020 time period compared to 2019, with worse outcomes also noted.
“During COVID, the number of new cases diagnosed decreased by 38% (43 NSCLC; 19 small cell lung cancer [SCLC]), compared to before-COVID period (67 NSCLC; 33 SCLC),” reported Dr. Reyes. “Among those hospitalized, the mortality during hospitalization was 44% vs 17% before COVID.”
Findings From TERAVOLT
Previously reported data on patients with thoracic malignancies who develop COVID-19 has suggested a higher mortality rate compared to the general population and to other cancer types, particularly in patients aged 65 or older or patients suffering from active or progressive disease.
The TERAVOLT study, a multicenter, international observational study composed of a cross-sectional component and a longitudinal cohort component that examined more than 1,000 patients with both lung cancer and COVID-19, found that overall mortality remains high, and male patients have significantly higher hospitalization and mortality rates compared to female patients. Importantly, researchers found no significant differences in COVID-19–related mortality among different racial or ethnic groups (Abstract P09.18).
Virtual Thoracic Prehabilitation
Although much of the world has moved to remote work and virtual meetings, there was concern about medicine's ability to adapt to the constraints caused by COVID-19. The use of telemedicine has flourished, but what role might it play for patients with complex diseases such as lung cancer?
Previous research has shown that patients with lung cancer who pursue an exercise regimen before treatment, a process known as prehabilitation, may increase their chances of survival. However, since the COVID-19 pandemic, the capacity to deliver face-to-face hospital appointments has significantly been reduced. If these crucial in-person visits are curtailed by COVID-19, patients may suffer.
However, a study by Stephanie Wynne, BSc, of Guy's Cancer Centre, Guy's and St. Thomas' NHS Foundation Trust, London, and colleagues demonstrated that virtual, home-based prehabilitation is feasible and may improve patients' presurgical physical activity levels and exercise capacity (Abstract OA08.04).
