COVID-19 disrupting clinical trials, changing ‘essential’ cancer treatments

Weighing up a patient’s mortality due to COVID-19 or cancer is the new reality for oncologists, research finds.

Researchers at the University of Sydney School of Social and Political Science, together with colleagues from Duke University (US), are examining how the pandemic is altering cancer treatment – for better or worse – in both Australia and the US. The 30 percent decrease in melanoma checks in Victoria is just one example of this.

In addition to doctors weighing up the risks of administering standard treatments, the researchers have identified the suspension of clinical trial activities as a key issue.

Their analysis, published in American Association for Cancer Research journal Clinical Cancer Research, also outlines the benefits and drawbacks of virtual consults, as well as the economic implications of a changed cancer treatment landscape – for patients and practitioners.

“In light of physical distancing restrictions due to COVID-19, standard cancer procedures are being altered or delayed, including surveillance imaging; non-emergency surgical procedures; and clinical trials,” Sydney lead and health sociologist, Professor Alex Broom said.

“The suspension of clinical trials is especially detrimental for patients with rare cancers. For them, enrolling in a clinical trial for a promising new therapy may be the best option.”

Many experimental labs where materials, including potentially hazardous ones, are handled have also been shut due to the pandemic, leaving a gap in both research and clinical care. “In some cases, these ‘wet labs’ are involved in the development of personalised therapies, such as adoptive cellular therapies (mostly used in the US), which use a person’s immune cells to fight cancer,” Professor Broom explained.

A silver lining to cancer treatment upheaval, however, has been the increased identification of non-essential drugs and better identification of treatments which do not offer significant improvements to quality or quantity of life. An example is palliative chemotherapies, which, the accumulating evidence shows might not be worthwhile given the risks posed by the pandemic in administering the treatment.

Some cancer patients are especially vulnerable to COVID-19 due to their immunocompromised status, and hence, their increased vulnerability to infection.

To this end, Professor Broom relayed the thoughts of an Australian participant in the study: “I saw other people carrying on about it and I thought, ‘If you get COVID, you’ll probably survive, but I won’t. I mean, we already know that anyone with anything wrong with their lungs or heart, you’ve got very little chance of fighting this thing…”

For these patients, the transition to virtual consults has been successful, and will likely endure.

…the clinical encounter in oncology is not only an exchange of facts about disease, or a neutral forum for making decisions about treatment; it also has social, moral, and ritual significance

On the flipside, “moving the physical clinic to the virtual environment has a number of negative effects on doctor-patient interactions,” Professor Broom said. One such effect is the creation of ’emotional distance’ between doctor and patient. “We know that the clinical encounter in oncology is not only an exchange of facts about disease, or a neutral forum for making decisions about treatment; it also has social, moral, and ritual significance,” Professor Broom said. “Such dimensions simply do not translate as well in a virtual setting.”

One study participant said “…results-wise, it was fine for having the doctor on speaker and just getting my PET scan results. But I also thought, ‘Oh, I really wouldn’t want to get negative news via the phone’.”

Added to this, with virtual consults becoming standard, the ‘digital divide’ – inequitable access to the internet resulting in further disadvantage – is likely to deepen in the cancer treatment space. “In the US and Australia, we might expect to see patients from low-income backgrounds, in rural areas with reduced internet connectivity, affected by this,” Professor Broom said.

The analysis found that COVID-19 is already having financial implications for oncologists. Aside from the suspension of many treatments, with COVID regulations and policies changing day-to-day, it is unclear whether certain services will remain chargeable. For example, in the US and Australia, telehealth interactions have become chargeable, yet it is unknown whether this will persist, post-pandemic. “Accordingly, an expectation that oncology can adapt without unintended financial consequences – for practice and care – is naive at best,” Professor Broom said.

“The literature on pandemics and major social upheaval suggests that we won’t return to ‘normal’. Oncology is not immune from this: it is unlikely to ever be the same post-COVID-19 and we need to be proactive in studying the ongoing effects” Professor Broom said.

“Changes to the field will be exacerbated by burgeoning rates of unemployment leading to people’s reduced ability to pay for treatments and further mental health challenges.

“In two upcoming studies which we will run, therefore, we will explore ways to combat present and future issues faced by oncology patients and practitioners.”