COVID’s impact on cancer care and oncology research has been devastating, but the pandemic has also opened up opportunities to take learnings and create long-lasting change in research, practice and education, says Lucid’s Frances O’Connor.
The COVID-19 pandemic might finally be in its latter stages after a year and a half of disruption, but its impact on oncology is likely to last much longer – with potentially devastating effects on long-term survival.
These ‘lost years’ in cancer care are a result of many cumulative factors – we’ve seen diagnosis delays, treatment delays, missed scans, missed face-to-face appointments and detrimental changes in treatment and pathway changes; for instance those with slower growing cancers being put on watch and wait regimens instead of treatment to avoid clinic time. As we look to the future, collaboration is key on many levels.
The last 18 months have seen some incredible scientific leaps directly tackling the pandemic, brought about by unprecedented alliances seen between pharma companies and between academia and pharma. However, the impact on many other areas of research, including cancer, cannot be ignored. According to the ICR, cancer research has faltered due to the closure and restrictions placed upon labs, redirection of resources to COVID research as well as trial enrolment issues and sample collection challenges. They also note that the livelihood of researchers has been impacted profoundly given the changes and even terminations of some research programmes.
Data collection is a real issue due to many patients shielding because of their immunocompromised status. Treatment approvals have, and will, be impacted where registrational trials were undertaken in this time with many deviations from the set out statistical analysis plan. It is of paramount importance to get our trials back on track – perhaps the more extensive collaborations we have seen during the pandemic could be a way to regain some of the ‘lost years’, and it’s time for a much more egalitarian or revolutionary approach to oncology research. The American Society of Clinical Oncology (ASCO) has published an extensive report outlining learnings from the pandemic and setting out key pillars for future research and delivery of care.
Using innovative, collaborative, digital randomised trials in oncology is one such bright idea. The super-smart COVID-19 Recovery trial is a successful example of a platform trial, which has shown us how large clinical studies can be run in an agile way and be set up much quicker, evaluating several interventions against a common control, pooling datasets and minimising the data that each clinical team needed to collect about each patient, keeping it as fast and straightforward as possible.
In cancer, where there are lots of combinations to be tested in late-line therapy, a trial that can adapt as the treatment paradigm evolves comes with a lot of advantages – there is an opportunity here for bigger, more efficient multisponsor studies.
With the continued difficulties researchers face, virtual, decentralised approaches, where a patient never has to go to a research site for assessments are a good option to keep the pace, and perhaps speed up, continued research.
When it comes to revolution, one clear positive is that the pandemic has magnified the value of real-world evidence (RWE) in oncology and the community is giving this topic the focus it deserves – so much so, that there was significant discussion at ASCO 2020 surrounding telemedicine, accounting for missing data, obtaining laboratory tests and images locally, using remote informed consent procedures, and additional considerations for continuing ongoing clinical trials and initiating new ones.
With the very real concern that we are on the cusp of entering an endemic world, RWE is important in a world with constantly changing goalposts where we need to understand the impact on our patients now and in the future. Partnerships like that between Roche and Flatiron Health will help to develop even further robust approaches allowing this evidence to feature more in regulatory decision making.
The pandemic has highlighted the emotional impact on the oncology community. Treaters feel they are not making the difference they would normally and have had to constantly innovate against an evolving enemy with uncertain guardrails. Some have even stepped into front-line, COVID-treating shoes. As a result, many of these professionals are facing burnout (Hlubocky et al. JCO Oncol Pract 2021).
Where appropriate, there are opportunities for pharma to collaborate and support oncologists with wider ‘soft skills’ training such as resilience and mindfulness or by offering support networks through their field force.
Cancer patients are enduring treatment changes and setbacks which have the very real potential to shorten lives. We have an ageing population dealing with isolation from family support, who are often the protagonists of appointments, calmers of health anxiety and nullifiers of healthcare avoidance, and these issues are leading to later presentation, and the potential for more advanced disease and worse outcomes overall.
It’s a challenging time for all, with systems and processes put in place to manage the risk of COVID which threaten the empathy of care. Our social distancing regulations have, for most, not allowed family members to accompany loved ones to appointments to support them, and coupled with the rise in telemedicine, have highlighted the many communication/education challenges we face. Companies such as ourselves exist to support healthcare professionals and patients by employing strategic problem solving to these challenges.
Sometimes, it’s the simple things that make the patient experience better – video calling a relative, recording (where this is possible) the diagnosis chat to refer back to, use of plain language summary documents etc, all of which is challenging when under the additional stresses of operating in a pandemic. Through our educational programmes, we have supported oncologists to understand motivations using MI techniques, we’ve encouraged deeper and more insightful conversations as well as thinking about overall aims, belief shifts and behaviour changes that are needed to help oncologists bring true value to their patients – but this value has sometimes been harder to achieve in a more remote world.
It has been mooted that remote consultation is, in part, here to stay. Coupled with the continual changes in practice, we will need to consider what best practice looks like, how we design education to support the changing environment, the different patient-physician interactions and how the changes in the status quo affect behaviour-driven considerations to keep improving patient outcomes.
We have ensured we allow more timepoints for collaboration with our steering committees and insight gathering when designing educational programmes throughout the pandemic, thus allowing us to pivot quickly to address changing needs and fix the healthcare problems within the community we are addressing – rigorous outcomes measurement has been crucial to this agility.
Insights gained from our oncology programmes throughout the pandemic have included the need to be laser-focussed on impact, understanding what is relevant, what is evidence-based and what is practical, and avoiding what is too ethereal or full of conjecture at the same time. Sometimes less really is more.
A more fundamental lesson from COVID is the importance of getting bigger, more diverse groups of people to talk to each other more, breaking down silos, working for the best interests of the patients, and a singular focus on the task at hand. Some amazing networks have arisen over the pandemic – some as simple as WhatsApp groups of immunologists from multiple countries, who discuss what they’re seeing as the situation evolves.
To harness that and bring together people from different vistas would be such a positive learning to take from the pandemic – and it is something pharma could really help facilitate. More joint working across industries, geographies and disciplines coming together to solve the ‘big questions’, embarking on a journey to find the best way forward together on our journey to cure cancer – wouldn’t that be really something?
Frances O’Connor has 15 years of medical communications experience. She started her career in contract research organisations giving her a good grounding in clinical development. During her career, Frances has been responsible for the strategy and delivery of global and regional, pre-launch, peri- and post-launch communication programmes for many assets with oncology featuring in her top three therapy area specialism. Frances is passionate about storytelling and innovation. She is fanatical about insight, understanding behaviours and decision making, and engaging groups of very special individuals who want to be and want to deliver the very best they can as part of a high performing team creating the best outcomes for the patients we serve.
Founded in 2007, Lucid Group is a global multi-capability healthcare communications company. We partner with the pharma and biotech industry to deliver pioneering solutions that change behaviour, improve clinical practice and advance health outcomes.
Ultimately, we transform lives by fixing healthcare problems.