ASCO Addresses Changes in Cancer Care Due to the COVID-19 Pandemic

The American Society of Clinical Oncology (ASCO) and its affiliate organization the Association for Clinical Oncology announced the results of a survey that addressed the changes in cancer care due to the coronavirus disease 2019 (COVID-19) pandemic.¹

Specifically, the results tracked the initial impact of the COVID-19 pandemic on cancer clinical trials, highlighted a new research initiative to address the data gap on the effect of COVID-19 on individuals with cancer, and detailed possible next steps in the delivery of cancer care as systems begin to prepare for life after COVID-19.

“COVID-19 is placing an incredible strain on the cancer care system, causing tragic results for some patients with cancer and their families, but there has also been an unprecedented response by the oncology community, which is coming together and adapting in new ways,” ASCO President Howard A. “Skip” Burris, III, MD, FACP, FASCO, said in a press release. “While we’re in very tough times, this crisis presents an opportunity to improve the quality and resiliency of cancer care. To maximize that potential, we’ll be drawing on the expertise of the full cancer community, action by policymakers, and data to proactively transition to post-crisis cancer care and achieve the best outcomes for patients in the months and years ahead.”

Results which examined the initial impact of COVID-19 on clinical trials found that after only a few weeks into the pandemic, 60% of research programs reported halting screening and/or enrollment for certain clinical trials.² The findings, published in JCO Oncology Practice, also indicated that more than two-thirds of the survey respondents reported using remote visits to replace clinical trial visits, even with research sites facing challenges of implementing telehealth. 

Further, respondents also reported a decline in the ability or willingness of patients to come to the site, as well as limited availability of radiology, surgery, cardiology, and other services that are necessary for some clinical trials. The authors of the article called for the cancer research community to evaluate the impact of clinical trial protocol modifications during the pandemic to determine if trials can safely and successfully continue once the pandemic has ended.

“It is crucial that ASCO and other research organizations continue to monitor the situation, collect feedback from stakeholders, and identify effective strategies for navigating the evolving situation,” the authors wrote. “At the same time, study sponsors, research programs, and regulatory agencies should recognize that protocol modifications and deviations are inevitable and should be documented and reported. The most important consideration for trial programs during these uncertain times should be to ensure the safety of patients, providers, and research staff.”

Understanding that policy actions at the federal level are essential, the Association for Clinical Oncology also announced an advocacy agenda for congress and the administration.³ The agenda detailed 8 policy changes necessary to sustaining high-quality cancer through the remainder of COVID-19, including:

• Continued support for telehealth and full reimbursement for audio-only visits.

• Additional and immediate financial support for practices. 

• Passage of The Cancer Drug Parity Act, which would prohibit the currently unequal cost sharing between oral and IV drugs. 

• Action to prevent additional drug shortages.

• Adapting clinical trials through models such as decentralization of trials.

Additionally, in order to re-establish cancer care following COVID-19, ASCO announced a “Road to Recovery” initiative, which they suggested will be informed by lessons learned in the current environment.⁴ Moreover, ASCO will convene 2 multidisciplinary workgroups to chart a course for this recovery. The workgroups, which will develop a blueprint with recommendations on policies or practices to support recovery, will be made up of patients and patient advocates, as well as experts from surgery, medical oncology, radiation oncology, oncology nursing, supportive care, clinical research, and practice administration. Additionally, the workgroups will interact with other stakeholders in clinical care and research.

“Lessons learned from the pandemic may highlight new or unforeseen areas of opportunity or need that should be considered as part of any recovery,” ASCO wrote. “It is important to understand their impact and to identify whether and how modifications made to care delivery and research during an emergency could be adopted as new standard practices to support safer, more effective, and higher quality care and research in the future.”

References:

1. ASCO. New Clinical Trial Data, Initiatives, and Path Forward for Post-COVID-19 Cancer Care Delivery System Announced. ASCO website. Published April 23, 2020. asco.org/practice-policy/policy-issues-statements/asco-in-action/new-clinical-trial-data-initiatives-and-path. Accessed April 24, 2020. 

2. Waterhouse D, Harvey RD, Hurley P, et al. Early Impact of COVID-19 on the Conduct of Oncology Clinical Trials and Long-term Opportunities for Transformation: Findings from an American Society of Clinical Oncology Survey. JCO Oncology Practice. doi:10.1200/OP.20.00275.

3. ASCO. ASCO COVID-19 Recommendations to Sustain Access to Cancer Care. ASCO website. Published 2020. asco.org/sites/new-www.asco.org/files/content-files/blog-release/pdf/2020-asco-covid-19-advocacy-agenda.pdf?cid=DM4954&bid=42598701. Accessed April 24, 2020.

4. ASCO. The Road to Recovery: Cancer Care and Research in a Post-COVID-19 World. ASCO website. Published 2020. asco.org/sites/new-www.asco.org/files/content-files/blog-release/pdf/2020-the-road-to-recovery-covid19-april2020.pdf?cid=DM4954&bid=42598701. Accessed April 24, 2020.