April 16, 2022
5 min read
Although much is known about the effect of COVID-19 on people with cancer, the effect on screening is becoming clearer.
A growing body of data estimates that the pandemic resulted in 22 million lost or canceled cancer screenings in the United States in just a 4-month period in 2020.
This has led to an increase in the diagnosis of later cancers that typically require more complex care.
A study by the American Cancer Society – conducted in 32 local health centers serving lower-income populations – showed that mammography screening fell by 8% among women aged 50 to 74 in the first 2 years of the pandemic. Researchers concluded that this reduction in screening could lead to 47,517 fewer mammograms and 242 forgotten breast cancer diagnoses.
In another analysis, Harvard School of Public Health investigators estimated that there would be a 10% to 14% increase in cancers diagnosed in 2021 and 2022, with a higher percentage being advanced-stage cancers.
Investment in radiation therapy
Investments in radiation therapy (RT) may be particularly necessary in the coming months and years, as this wave of later cancer diagnoses exacerbates the existing gap in access to RT that existed before the pandemic.
Despite its important role in improving survival and quality of life, millions of people worldwide lack access to radiation therapy, as low- and middle-income countries have 80% of the global cancer burden but only have access to 32% of global radiation therapy resources.
It is also estimated that although 50% to 60% of all cancer patients need radiation therapy, 40% to 60% of them lack access to it.
Even in developed economies, access may vary based on geography or socioeconomic status, with cutting-edge radiation therapy more readily available in large cities with academic centers dedicated to cancer treatment and research than in rural hospitals.
In addition to relieving metastatic symptoms, RT has been widely used for brain metastases, and data are being developed that support the use of RT to delay progression and improve OS among patients with low-volume metastatic disease in several cancers.
The Phase 2 SABR-COMET study evaluated stereotactic ablative RT for the treatment of metastases in patients with multiple cancers. Most study participants had lung, breast, colorectal, or prostate cancer. The results showed an OS benefit with the addition of metastasis-directed RT to systemic therapy.
An ongoing trial at the Holland Cancer Institute-Antoni van Leeuwenhoek Hospital is evaluating high-field magnetic resonance-guided RT (MRgRT) for the treatment of oligometastatic disease among patients with primary prostate, kidney cell or colon cancer, as well as melanoma.
More straight access
By preparing for the potential surge of patients with late-stage cancer due to pandemic-related screening delays, clinicians and care centers can position themselves to provide broader and more equal access to critical cancer treatments, including RT.
GenesisCare – a leading global oncology provider with more than 200 radiotherapy centers in four countries – is leveraging its RT capabilities to prepare for a potential increase in late-stage cancer patients.
Several of the strategies it pursues may provide a roadmap that other cancer centers may consider as part of their own proactive initiatives to prepare for this looming wave.
A key objective is to formulate and implement strategies to support remote centers in developed and developing countries with highly technical services for remote treatment planning, reducing the cost of having these centers open.
Another is preparing for an increase in the demand for functional imaging (eg PET), which can detect metastatic disease more accurately and support optimized treatment decision making.
Meeting the growing demand for PET imaging includes building capabilities with molecularly targeted PET imaging, including prostate-specific membrane antigen PET tracers that are FDA-approved or awaiting FDA approval for use among men with metastatic prostate cancer.
Another important strategy to address the historical gaps in RT access and the growing need for RT services is to invest in and use more advanced cancer treatment technologies that help optimize each patient’s treatment based on his or her specific needs.
High-field MR-Linac systems can allow RT to be used in cancers that are not susceptible to more traditional forms of radiation therapy; can support hypofractionated regimens that significantly reduce treatment time; and allow automated real-time adaptive therapy that can improve patient outcomes while streamlining clinical workflows.
Ensuring access to high-field MRgRT is essential to improve health and optimize the safety and efficacy of RT in a growing number of cancer indications.
Brachytherapy is another RT approach that may be useful in treating advanced primary cancers and metastatic lesions. New technologies and applicators make it easier than ever to administer brachytherapy efficiently, safely and effectively with fewer manual steps.
Investing in advanced brachytherapy systems will be important to increase the capacity and efficiency of care delivery, both of which are essential to ensure that brachytherapy services are available to as many patients as possible.
Optimization of multimodal care
Optimizing care for patients with advanced cancer also requires the support and strengthening of collaboration between radiation, medical, and surgical oncology communities to ensure coordinated patient care.
Multimodal therapy is a pillar in cancer treatment and is increasingly used in later stages of the disease, as evolving treatment regimens integrate several strategies. Optimizing multimodal care requires close and effective communication and coordination between medical, radiation and surgical oncologists, as well as oncological nursing and support staff.
COVID has made it more challenging to create an interdisciplinary and collaborative environment, especially given the need to comply with HIPAA requirements when using video conferencing strategies. However, a potential golden edge of the pandemic is the accelerated development and implementation of HIPAA-compliant technology-based collaboration platforms.
Use of these platforms has played a key role in giving patients access to care providers over the last 2 years, but they can also be implemented to facilitate collaboration and data sharing between care teams. This can allow more team members to participate more often than might have been possible, as participating in person was the only option, especially if team members work in multiple locations.
Finally, meeting the current demand for RT requires the provision of additional capacity to increase resilience as well as a commitment across RT and medical education communities to increase the number of radiation oncology professionals trained in the latest technologies and latest insights into cancer treatment.
Solutions such as Global rounds on Earth can help connect physicians from around the world with expert committees to guide evidence-based practices and online learning practices for technically complex or new procedures.
In addition, experience from the past 2 years in making cancer treatment available in extremely difficult environments should be incorporated into routine policies and practices to improve and expand access to high-quality RT and effective patient and provider support resources.
The capacity and resilience we are building now can improve care today as we prepare to meet tomorrow’s challenges.
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Scherer L. Cancer trends: How has the COVID-19 pandemic affected cancer screening? Everyday health. Published May 14, 2021. Opened April 11, 2022.
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For more information:
Bridget Koontz, MD, is the U.S. Chief Medical Officer and Deputy Global Chief Medical Officer at GenesisCare. She can be contacted at [email protected]