AACR Report Highlights How COVID-19 Touches Every Aspect of Cancer Care and Research

Antoni Ribas, MD, PhD, FAACR

The long-term dramatic effects of the COVID-19 pandemic on cancer research and patient care present several challenges but also future opportunities, according to findings in a report from the American Association for Cancer Research (AACR). The AACR Report on the Impact of COVID-19 on Cancer Research and Patient Care navigates the lessons learned over the past 2 years as guideposts for building policies to better equip physicians to deliver optimized care.

“[The pandemic] isn’t over for health care workers, by any means,” Amy Klobuchar, United Sates Senator for Minnesota, said during the opening remarks for an AACR webinar on the report. “Because of the pandemic, many individuals have been delaying physicals and routine exams, including the kinds of tests that can [detect] cancer early. There are thousands of individuals walking around with undetected cancer because they aren’t going in to get that preventative care. We need to do more to make sure people have the resources and information they need to access this potentially life-saving care.”

Although the United States accounts for approximately 4.25% of the global population, it accounts for 19% of COVID-19 cases worldwide. The United States has also tallied 15% of the global COVID-19 deaths. Underlying conditions, including cancer, have been shown to increase the risk of an individual developing severe disease as a result of SARS-CoV-2 infection.

Patients With Cancer At Increased Risk

Patients with hematologic malignancies, lung cancer, and those receiving B-cell targeted treatments are the patients with cancer who are among the most vulnerable. Compared with individuals with no history of cancer, results of a study of more than 73 million patients in the US showed that the risk of COVID-19 infection was 7 times higher in patients diagnosed with cancer in the past year.

For example, patients with COVID-19 and lung cancer experienced higher intensive care unit admission rates (16%) vs 3% for those with COVID-19 alone. Moreover, patients with cancer who received an anti-CD20 treatment had a mortality rate of 45% compared with 12% for patients with cancer and COVID-19 being treated with an anti-JAK inhibitor.

Overall, hospitalization rates for patients with COVID-19 and cancer were 47% compared with 24% for patients with COVID-19 alone. The 28-day COVID-19 mortality rate was nearly double for patients with cancer vs those without (28% vs 16%, respectively). Patients with COVID-19 who had active cancer were also more likely to die than patients with no history of cancer (34% vs 20%).

The COVID-19 pandemic also had a pronounced effect on the incidence of cancer screenings; approximately 10 million screenings were missed from January 2020 to July 2020. Screening rates declined in April 2020 compared with the average for the same month over the previous 5 years by 87% and 84% for breast cancer and cervical cancer, respectively. Colorectal cancer screenings also declined 80% from March 18, 2020, to May 4, 2020, vs the period from January 29, 2020, to March 17, 2020.

However, more recent evidence points to cancer screening rates rebounding to prepandemic levels. Findings from a study that compared screening rates for breast and colorectal cancer before March 13, 2020, with rates after showed that rates for breast cancer recovered almost fully (88 screenings per 10,000 patients before March 2020 vs 88 per 10,000 patients in July 2020). Colorectal cancer screenings decreased slightly over the same period of time, from 15 per 10,000 patients to 13 per 10,000 patients.

The preventative measures used to limit the spread of COVID-19 negatively effected several aspects of cancer treatment. As many as 87% of patients with cancer reported delays in their planned surgery at the height of the COVID-19 pandemic vs prepandemic levels. The authors of the report highlighted a “staggering” 95% reduction in biopsies was observed compared with prepandemic levels.

“One of my first actions as president of the AACR in early 2020 was to launch a task force dedicated to supporting patients with cancer during the pandemic,” Antoni Ribas, MD, PhD, FAACR, president, AACR, and the director of the Tumor Immunology Program at the Jonsson Comprehensive Cancer Center at the University of California Los Angeles, said during the webinar. “The pandemic has caused significant challenges for cancer investigators, including the closing of laboratories, interruption of clinical trials, and the reduction of career advancement opportunities, especially for women and minority early-career scientists.”

Cancer Research Takes a Hit

To evaluate the effect of the COVID-19 pandemic on cancer researchers, the AACR surveyed 247 investigators across North America, Europe, and Asia in early January 2022. Among 66 responders who completed the survey, 32% were postdoctoral fellows, 23% were assistant professors, 16% were either associate professors or professors, 7% were instructors, and 6% were physician scientists.

Nearly all (99%) responders noted that COVID-19 had negatively effected their research, career in cancer research, and/or patient care. Eighty-seven percent of those who completed the study strongly agreed/agreed that COVID-19 affected their productivity. Laboratory shutdowns and funding ramifications were also prevalent; 66% reported shutdowns and 60% said their funding was affected. The pandemic reportedly delayed career advancement for 61% of responders.

As a safer option for oncologists to continue to deliver patient care, telehealth use was 38-times higher in July 2021 compared with prepandemic levels. Patients with cancer preferred telemedicine 45% of the time vs 34% of patients who selected an office visit. Reduced travel time and reduced risk of exposure to COVID-19 infection were among the most-selected rationales for telehealth, accounting for 42% and 37% of patients with cancer surveyed, respectively. 

“[The increase in telehealth use] was facilitated by waivers, increased coverage for telehealth visits for both public and private health insurance—this accelerated the adoption,” Ana Maria López, MD, MPH, a professor and the vice chair of medical oncology at Sidney Kimmel Medical College in Philadelphia, Pennsylvania, said in the webinar. “I often say that, in [1] month, we did what 70 years would have done under normal circumstances. Telemedicine enhances health equity by expanding access to care.”

The authors of the report concluded with recommendations for steps that could be taken by the federal government to support patients with cancer through the remainder of the COVID-19 pandemic, and to lessen the effects on cancer care and research that could come with a future pandemic. The AACR called for funding to be properly allocated to invest in medical research, strengthen public health infrastructure, expand access to telehealth, and modernize clinical trial development. The report also cited the collection of high-quality public health data, effective testing/infection tracing, and the combatting of misinformation in order to build confidence in public health as key areas to combat a future pandemic.

Reference

1. American Association for Cancer Research. AACR report on the impact of COVID-19 on cancer research and patient care. Published February 9, 2022. Accessed February 9, 2022. aacr.org/COVIDReport