The pandemic has brought with it an exceptional set of challenges, but it has been remarkable to see the collaborative spirit, grit, and determination of people and healthcare systems to adapt and overcome these challenges. We have also seen human ingenuity at its best: businesses quickly adapting and moving online to make essential supplies available to all, doctors practicing karaoke to uplift the spirits of sequestered patients, and Tommy the robot nurse that was used to monitor human vitals and communicate them from afar in a hospital in Italy. We have prevailed through pandemics in the past, and this time too, I am confident that our resilience will steer us towards a healthier future. However, we need to acknowledge that the pandemic has changed our world in irreversible ways, and as we grapple with this ‘new reality’, today, we need to think about vulnerable segments of our community who have faced the worst of it.
Many patients have been negatively impacted by the pandemic and measures taken to curb its spread. With cancer patients, we have often seen a disruption in the continuum of care by delays in diagnosis, postponed appointments and missed treatments.[1,2,3] In the US, during the peak of the pandemic in April, screenings for breast, colon, prostrate, and lung cancers were lower by 85%, 75%, 74%, and 56% respectively. In Europe, we have seen a 60% reduction in biopsies and 72% of the scheduled surgeries have been delayed. With the pandemic continuing to spread, the initial estimates are only expected to rise raising concerns about the implications in the longer-term, which still remain unclear.
How the pandemic impacts cancer patients
The wide-scale disruption to healthcare delivery has had a significant effect on the emotional well-being of cancer patients as they face fear and uncertainty, and limitations in their environment. Many of us have been impacted by cancer in one way or another. For most patients diagnosed with cancer, uncertainty becomes a common fixture – uncertainty about the diagnosis, treatment and, in some cases, their own life expectancy. The pandemic has only made it more difficult for these patients as they struggle to navigate the tenuous path between continuing their cancer treatment and the fear of exposing themselves to the COVID-19 infection.
Patients face complex decisions: continuing treatment in the hospital may treat and control their disease but may also expose them to infections. While on the other hand, delaying treatment might reduce the risk of exposure but may result in progression of the cancer. These are very daunting decisions to be faced with, especially since patient organisations, which form a critical system of support for patients have had to cut down on their operations due to financial constraints..All of the social and economic changes put additional pressure on patients, their families and caregivers.
How the pandemic impacts healthcare systems
There are more than 100 different types of cancer with different prognosis, each requiring diverse modalities of care and treatment..In many countries, the steep rise of COVID-19 cases during the spring of 2020, combined with pre-existing resource scarcities, left no time to train staff on the specificities of intensive care, therefore, cancer staff members had to be repurposed urgently. As every country took measures to address the rising number of cases, the cumulative impact seen everywhere was a scarcity in oncology departments that adversely effected cancer care and treatments.As healthcare systems continue to struggle with increasing numbers of COVID-19 cases, physicians are now faced with the dilemma of weighing the intended benefits of planned cancer treatments against the new threat of COVID-19.
The silver lining
These ongoing challenges and uncertainties have forced us to re-think the way our healthcare systems function and sustainability will be key in reorganising the way we perceive, promote, and administer care. It is also imperative for us to put policies and strategies in place to ensure that our healthcare systems are not overwhelmed with the predicted spike in advanced cancer cases – as a result of delayed diagnosis, missed treatments – that we might see in a post-COVID-19 world.
We have seen telemedicine and artificial intelligence (AI) play a significant role in helping reduce treatment gaps. The use of telemedicine comprising video, telephone and other electronic communication has risen substantially from around 10% of general medicine consultations before COVID-19 to approximately 75% during the peak of the pandemic, in the UK. With telemedicine, physicians can manage their work load better and this, coupled with augmented AI will go a long way in optimising remote modes of administering treatment. However, certain kinds of cancer, which are hard to diagnose early – e.g. pancreas-carcinoma, myeloma, or lung-tumours – need face-to-face referrals. But, the challenge remains in establishing which patients are best suited to which mode of consultation – telephone, video, or face-to-face, and to what extent can AI enhance this.
The International Monetary Fund reported that the pandemic has caused approximately 17.5 trillion dollars in additional global debt. This is going to place a massive economic burden on healthcare services moving forward and there are serious decisions to be made about where we invest, how we invest, and how we deal with the paradox of healthcare and debt. We need to look at cost-saving solutions that are efficacious and accessible to patients in need. This is where biosimilars can play a huge role. It’s been almost 15 years since the launch of the first biosimilar worldwide. And in the years gone by, we have seen how biosimilars have contributed towards facilitating long-term change and sustainability within healthcare systems. Biosimilars are more affordable alternatives to reference biologics, are approved via well-established pathways[12,13] to match them in terms of safety and efficacy and are manufactured according to the same high-quality standards.[14,15,16] Beyond cost savings, biosimilars adoption has been also shown to improve access for patients, varying by country. In England for instance, the introduction of a biosimilar to prevent neutropenia in patients undergoing chemotherapy, resulted in a number of Strategic Health Authorities reassessing their guidance relating to this medicine. A subsequent change in guidance moved this biologic to a first-line treatment, resulting in an increase in the number of patients who could receive this much-needed treatment by 104%.
Biosimilars that are often available as treatment options in acute and chronic cancer care offer viable solutions to increasing access for patients and bringing down these looming healthcare costs. As we see an increasing number of higher priced biologics going off patent, we see a huge potential and opportunity for biosimilars where both patients and healthcare systems are the winners. We have the solutions, but it is up to us if and how we choose to implement them.
Uncertain and challenging times force us to break with the status-quo and re-imagine new ways of conquering these challenges. Collaboration, flexibility, and adaptability to new and innovative approaches to delivering care will be fundamental in how we deal with the emerging challenges of a post-COVID-19 world. I am hopeful that we overcome these trials with empathy and compassion leading the way for generations to come.
Professor Michael Wiechmann is global head of Medical Affairs, Biopharmaceuticals, at Sandoz
- European Cancer Organisation. The Impact of COVID-19 on Cancer in Europe: The 7-Point Plan to Address the Urgency and Build Back Better. Available at: https://www.cirse.org/wp-content/uploads/2020/12/Impact-of-COVID-19-on-Cancer_7-Point-Plan_Final-1.pdf [Accessed January 2021].
- Patt D, Gordan L, Diaz M, et al.Impact of COVID-19 on Cancer Care: How the Pandemic Is Delaying Cancer Diagnosis and Treatment for American Seniors. JCO Clinical Cancer Informatics. 2020 Nov;4: 1059-1071. DOI: 10.1200/cci.20.00134.
- Abdul RJ, Hakan A, Giuseppe C, et al. Impact of the COVID-19 Pandemic on Cancer Care: A Global Collaborative Study. JCO Global Oncology. 2020 Sep; 6: 1428-1438. DOI: 10.1200/GO.20.00351.
- IQVIA Reports. The Impact of COVID-19 on Cancer Treatment Across the EU5 Countries. Available at:https://www.iqvia.com/blogs/2020/07/the-impact-of-covid19-on-cancer-treatment-across-the-eu5-countries [Accessed January 2021].
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- World Ovarian Cancer Coalition. The Impact of COVID-19 on Cancer Patient Organizations (2020). Available at:https://worldovariancancercoalition.org/wp-content/uploads/2020/06/The-impact-of-COVID-19-on-Cancer-Patient-Organisations-12th-June-2020-FINAL.pdf [Accessed February 2021]
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- Alex B, Katherine K, Alexander P, et al. Clin Cancer Res November 15 2020 (26) (22) 5809-5813; DOI: 10.1158/1078-0432.CCR-20-2989.
- Becky M.Could telemedicine solve the cancer backlog? The Lancet Digital Health. Published: August 06, 2020. DOI: https://doi.org/10.1016/S2589-7500(20)30194-1. Available at:https://www.thelancet.com/journals/landig/article/PIIS2589-7500(20)30194-1/fulltext#articleInformation [Accessed January 2021].
- The International Monetary Fund Annual Report 2020. Available at: https://www.imf.org/external/pubs/ft/ar/2020/eng/ [Accessed January 2021].
- IMS Institute for Healthcare Informatics: Delivering on the Potential of Biosimilar Medicines report. IMS Institute Report. March 2016. Available at: https://www.medicinesforeurope.com/wp-content/uploads/2016/03/IMS-Institute-Biosimilar-Report-March-2016-FINAL.pdf. [Accessed January 2021].
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- Dutta, B., Huys, I., Vulto, A.G. et al. Identifying Key Benefits in European Off-Patent Biologics and Biosimilar Markets: It is Not Only About Price!. BioDrugs 34, 159–170 (2020). https://doi.org/10.1007/s40259-019-00395-w.