The spread of COVID-19, and the devastating health impacts the disease can have on patients with cancer, could put at risk years of steady progress in lowering cancer deaths among Americans, the director of the National Cancer Institute warned Saturday.
With hospitals across the country stretched thin by COVID-19 cases, cancer care has been disrupted. The risk of coronavirus infection, and the social distancing strictures put in place in response, have made clinical visits, laboratory tests and tumor imaging harder to complete. Many clinical trials — a critical component of treatment for patients with late-stage cancer — were put on pause.
"We know that delayed diagnosis and delayed therapy lead to worse outcomes for patients with cancer," said Ned Sharpless, head of the NCI, in comments to oncologists and cancer researchers tuning into the American Society of Clinical Oncology's virtual annual meeting.
"What we don't know yet is the scale of these bad outcomes. How many delayed diagnoses and delayed treatments over how long will constitute lost ground, progress undone and reverses in positive trends?"
For nearly three decades, the rate of cancer deaths in America has declined each year, falling from a peak of 215 deaths per 100,000 people in 1991 to 152 per every 100,000 in 2017, according to data from the American Cancer Society. The last year-over-year change on record, a 2.2% drop between 2016 and 2017, was the largest observed by the group.
The impact of COVID-19, however, could slow those gains, Sharpless said, cautioning that the pandemic's impact could be felt over several years.
In the near term, infection with the new coronavirus appears to be more deadly in patients with cancer than in the general population, according to data from a new study presented online through ASCO Saturday. Data from the case series were made available on May 28 and published in The Lancet.
Within 30 days of diagnosis, half of 928 cancer patients identified and tracked anonymously through a grassroots collaboration of doctors and researchers at more than 100 hospitals were hospitalized and 13% had died. Both numbers are substantially higher than what's been observed broadly for COVID-19 cases, although the study's size and retrospective nature limit how generalizable its findings are.
That rates of death from COVID-19 appear higher in patients already sick with cancer is perhaps not surprising. But the study, thought by its authors to be the largest case series of cancer patients with COVID-19, helps to fill a gap in research.
Importantly, the researchers found no significant association between recent surgery or chemotherapy and deaths 30 days after diagnosis with COVID-19.
"The biggest message here is that if you need treatment for your cancer that could be curative — surgery, radiation, some sort of chemotherapy — you really still should have it," said Toni Choueiri, director of the Lank Center for Genitourinary Oncology at the Dana-Farber Cancer Institute, in comments emailed to BioPharma Dive.
Choueiri is on the steering committee of the group that conducted the study, called the The COVID-19 and Cancer Consortium. Now expansive, the group started in March with a tweet sent by a medical resident at the University of Connecticut. Cold calls and emails between physicians active on Twitter quickly followed, leading five institutions to band together to begin a registry, Jeremy Warner, a member of the steering committee and lead author on the study, said in an interview.
It's one of several research collaborations now ongoing, including a recently launched effort by the NCI, that could help inform the treatment of cancer patients with COVID-19. Another, dubbed THERAVOLT, also presented research at ASCO showing patients with thoracic cancer to be at higher risk of hospitalization.
Over the longer term, COVID-19's impact could become more apparent in slowed or hampered clinical research of new cancer drugs.
Sharpless shared data on Saturday showing how patient accrual into NCI-run studies fell by half in March and April — disruption also felt by biotech and pharmaceutical companies. In response, the NCI took steps to help trials to adapt, like arranging for oral drugs to be shipped directly to patients or allowing centers to obtain patient consent remotely.
Even though some of the heaviest effects of COVID-19 on trial recruitment and enrollment may now be easing, Sharpless encouraged efforts to continue research when they can do so safely.
"Clinical trials are how we make progress for patients with cancer and these decreases in accrual will translate into reduced new approaches for patients," Sharpless said. "We certainly hope that, as circumstances permit, institutions and providers will resume accrual to ensure continued research progress."