Impact of COVID-19 on Cancer

Commencing the Opening session of the European Cancer Summit, Dr Mirjam Crul, Co-Chair of the Special Network on the Impact of COVID-19 on Cancer, emphasised the dramatic impact that the COVID-19 pandemic had on all areas of cancer care, which she witnessed herself at first hand as a hospital pharmacist in the Netherlands.

Against this background, the European Cancer Organisation quickly realised that a collaborative effort was needed to combine knowledge and address the urgency required.

This led to the establishment of a Special Network on the Impact of COVID-19 on Cancer, bringing together healthcare professionals, patients, researchers, academics and Community 365 Members, to collectively delineate and tackle the challenges posed by the pandemic on all areas of cancer care across Europe. The aim was to gather intelligence on the Europe-wide experience of the pandemic by the cancer community, identify shortages, knowledge gaps and organisational issues affecting cancer care, and define practical solutions. The Network also aimed to prepare healthcare services for the second wave of the pandemic and develop policy recommendations to redesign cancer services.

The Call to Action had an overwhelming response from the European cancer community, leading to the development of a 7-Point Plan to mitigate the impact of COVID-19 and cancer which was launched during this opening session,[1] as well as a Resolution, voted on at the end of the session.

Row 1 - Mirjam Crul (European Cancer Organisation’s Special Network on the Impact of COVID-19 on Cancer); Kathy Oliver (European Cancer Organisation’s Patient Advisory Committee); Véronique Trillet-Lenoir MEP (European Parliament’s Special Committee on Beating Cancer; MEPs Against Cancer Group). Row 2 - Mark Lawler (European Cancer Organisation’s Special Network on the Impact of COVID-19 on Cancer); Bente Mikkelsen (World Health Organization); John Ryan (DG Sante). Row 3 - Nicoletta Luppi (MSD Italia); Jens Spahn (Federal Minister of Health, Germany).

The Need for Real-Time Data

Professor Mark Lawler, Co-Chair of the European Cancer Organisation’s Special Network on the Impact of COVID-19 on Cancer, explained how it was clear early on that the pandemic was having a huge impact on cancer services. Indeed, anecdotal evidence suggested that “people were starting to fear a COVID-19 diagnosis more than a cancer diagnosis”.[6] But no-one had the data to either support or refute this statement.

To investigate further, a collaboration between DATACAN, the UK’s Health Data Research Hub for Cancer, of which Lawler is Scientific Director, and University College London was launched to analyse real-time data from hospitals across the UK.

The findings showed urgent two-week referrals for suspected cancer and chemotherapy attendance dropped significantly between March and June 2020, with over 70% of citizens with a suspicion of cancer not being referred to specialist services, and 40% of cancer patients not getting access to their chemotherapy treatment in a timely fashion. [7] Moreover, potentially 7000–18,000 of patients with cancer were at excess risk of death.

These findings, and others that Prof Lawler presented, indicated that while there has been significant progress in improving cancer outcomes over the last decade, the impact of COVID could mean that the advances of the last 10 years may have been lost in the last 10 months, unless we act rapidly and decisively.

The results Lawler presented underscored the absolute importance of near real-time data, demonstrating that rapid access to data provides the crucial cancer intelligence that can inform timely care for cancer patients.

Partially in response to the findings, which were the first to show the adverse impact of COVID-19 on cancer patients and cancer services in the UK, the UK government declared on 31 July cancer to be the “first priority” in the recovery of healthcare services following the pandemic.[8]

While the latest data suggest that urgent referrals are approaching normal for many cancers (although for cancers like lung cancer they still lag behind), Lawler said it is not enough. The ‘new normal’ cannot be the ‘old normal’ and we may need to be working at 130% of normal to help clear the backlog and find the ‘lost’ cancer diagnoses that have occurred during the pandemic lockdown. Unlocking the power of real-time data is key. Otherwise, Lawlor said, he is having to fight cancer, and COVID-19, with one hand tied behind his back.

The Benefits of Spare Capacity

Not all countries were affected equally, however. Jens Spahn, Federal Health Minister in Germany, said, while COVID-19 was a challenge in all countries, there were only a few isolated problems in Germany.

The numbers of people undergoing cancer screening dipped significantly during the pandemic, which is only acceptable for a very limited amount of time. However, the healthcare system in Germany has spare capacity and it adapted well and acted quickly to protect patients and healthcare professionals. Their testing strategy has also meant that everyone has access, and there has been a focus on care pathways to shield patients.

A Stress Test for Healthcare Systems

Véronique Trillet-Lenoir MEP, Rapporteur for the European Parliament’s Special Committee on Beating Cancer and Co-Chair of the MEPs Against Cancer, who is also an oncologist, said that the COVID-19 pandemic nevertheless has had and continues to have a severe impact.

Alongside delays in prevention, screening, treatment, rehabilitation and follow-up, there has been a shortage of medical supplies and reduced communication with patients.

Consequently, COVID-19 constituted a stress test for healthcare systems. While provisions need to be made in national cancer control plans for emergency strategies to respond to such crises, the aim must be to look at how to prevent the impact on patients with all non-communicable diseases (NCDs).

Trillet-Lenoir is recommending that the European Parliament plan healthcare better and reduce health inequalities. For the EU4Health programme,[9] she is advocating global prevention measures for patients with cancer patients and other NCDs, alongside a global strategy on medicine acquisition.

Magnifying Patient Fear and Uncertainty

Kathy Oliver, Vice-Chair of the European Cancer Organisation’s Patient Advisory Committee, and founding Co-Director and Chair of the International Brain Tumour Alliance (IBTA), stressed the impact of COVID-19 on patients, saying that fear and uncertainty have always been a part of the cancer journey, but that was magnified when the WHO declared a pandemic.

IBTA survey data suggests, early on, the majority of patients were afraid of visiting the hospital, while caregivers were worried about passing on the virus. Nevertheless, patients rated their doctors and nurses as the most trusted source on COVID-19.

Oliver believes, where healthcare systems are less resilient, such as in Eastern Europe, there is a danger the pandemic will make already existing inequalities profoundly worse. It is therefore all the more important that patient experiences are carefully catalogued and acted on.

Failing Patients with NCDs

Bente Mikkelsen, Director for Non-communicable Diseases at the World Health Organization, told the audience that the COVID-19 pandemic has laid bare how healthcare services have failed all patients living with NCDs.

Recent survey results suggest 42% of countries had disruption to cancer treatment, 40% had a lack of essential medicines, and 48% experienced disruption to palliative care.[10]

National COVID-19 response plans do not generally include NCD management. However, the WHO offers operational guidance to modify services and has a number of ongoing initiatives to improve cancer care.

The pandemic will nevertheless have lasting consequences for societies as a whole. Investing in preventing NCDs has to be part of the recovery, particularly as it offers a strong return on investment, as long as high-impact interventions are adequately implemented.

Learning Lessons to Build Resilience

John Ryan, Director of Public Health, Country Knowledge and Crisis Management at DG for Health and Food Safety, said that, until COVID-19, the main priority in the Directorate was Europe’s Beating Cancer Plan.[11] The pandemic significantly affected the entire cancer pathway, and it is important to learn lessons from this crisis to build more resilient cancer care systems, with the initial focus on the cancer care backlog.

Indeed, Ryan hopes much of the seven-year EU4Health budget will be focused on strengthening healthcare and improve outcomes, as well as improving the medicines supply chain. Alongside this, a digital revolution for healthcare will include the European Health Data Space with different types of data readily available and mobilising patient data more actively, as well as an upgraded knowledge centre on cancer.

No One Should Be Left Behind

Finally, Nicoletta Luppi, Senior Vice President and Managing Director at MSD Italia, reiterated how the COVID-19 pandemic has revealed the fragility of health systems, adding that they have not had enough time to prepare before the second lockdown.

While institutions find it hard to implement solutions in a timely and well-resourced manner, no one should be left behind and rapid decision-making is critical, while innovations such as alternative settings for vaccinations and screening hubs will be essential.

Europe needs to incorporate the WHO cancer programmes into Europe’s Beating Cancer Plan, and requires a greater focus on cancer prevention through vaccination, she said.