Published 09 November 2020
COVID-19 has posed one of the greatest health challenges of our generation, one way or another, impacting the lives of each and every one of us. For people with lung cancer, one of the most prevalent and deadly forms of cancer,1 the impact has been and will continue to be even more profound, given the similarity of symptoms and urgent need for early treatment. That is why now, more than ever, we have to work together as a community to find the best ways to provide support to people affected by this disease.2
Over the few last years, significant progress has been made in improving the diagnosis and treatment of lung cancer. As a result, mortality has been declining – with recent data suggesting a fall in lung cancer mortality of 6.3% each year from 2013 to 2016.3 However, COVID-19 is posing a real threat to this encouraging development. In the UK alone, for example, data suggest urgent lung cancer referrals fell by up to 75% during the first lockdown.4 Sadly, this does not mean there are fewer cases, but that fewer people are seeking and obtaining the diagnosis they urgently need.2 Unfortunately, these trends can be observed across countries globally.
Despite the progress that has been achieved in lung cancer care, it claims more lives every year than any other cancer.5 In the midst of the pandemic, there is an urgent need to ensure that people with lung cancer are not forgotten and we, as a society, do not fall into the trap of swapping one health crisis for another.
Challenges presented by COVID-19 for people with lung cancer
Increased barriers to earlier detection and treatment
All the progress being made in research, development and treatment, can only make a difference if people get diagnosed and treated. For cancers that progress quickly, such as lung cancer, diagnosis and treatment at the earlier stages of the disease may offer people the best chance of survival.2
However, even before the COVID-19 pandemic, research showed that people with lung cancer symptoms were hesitant to seek medical treatment due to the stigma or fear around a lung cancer diagnosis.6 The challenges presented by COVID-19 are exacerbating these barriers, highlighting the need to tackle them one by one with the hope of mitigating the longer-term impacts of this crisis.
- COVID-19 or cancer? A cough, breathlessness, or fatigue are innately linked with COVID-19. But these are also the most common signs and symptoms of lung cancer. Understanding the similarities and differences between the two can help identify when to seek medical advice and access appropriate care.
People with a new and continuous cough may be discouraged from visiting a healthcare centre, due to steps being taken to suppress the spread of COVID-19, and so there needs to be clearer guidance on signs and symptoms that the cough may not be COVID-19.
- Cancer doesn't wait. In the past few months, the pandemic has been monopolising headlines across the globe. With the continued focus on COVID-19, it is not surprising that there may be a perception that healthcare systems are prioritising COVID-19 above other conditions. Unfortunately, for a fast progressing disease such as lung cancer, any confusion over the urgency of seeking medical attention and subsequent delay in diagnosis and treatment may cost months, even years, of life. That is why it is critical that people with lung cancer symptoms recognise them as an emergency.7
Recognising this need, many countries are raising awareness about the need to get diagnosed. Cancer Australia, for example, is running a public health campaign, “Not Every Cough Is COVID-19” to highlight that respiratory symptoms may be a sign of cancer.8 This campaign, like many others worldwide, aims to cut through the noise and fight misconceptions that may delay a lung cancer diagnosis.
“Most of us are aware that health services tend to be operating at capacity, even in the absence of a pandemic,” Dr Anne-Marie Baird, President of Lung Cancer Europe, recently highlighted during the COVID-19 and Cancer: Expert Panel Discussion and Q&A. “The challenges and barriers for people with lung cancer do not start and end with the COVID-19 pandemic. This has only shone a light on the existing issues, around the capacity issues and the challenges of encouraging people to seek a diagnosis.9”
It is important to learn from the COVID-19 situation about when telemedicine is acceptable in the care pathway. It is not a case that one size fits all and we need to see where it works best in the patient pathway.”
- An added layer of fear. Visiting a healthcare centre with concerning symptoms can be worrying at the best of times and many are now fearful about the increased risk of contracting COVID-19. There is a risk that fear of exposure to COVID-19 may prevent people from entering the healthcare setting.10
Impact on treatments and outcomes
The impact of the pandemic is not limited to diagnosis –we are seeing how it is also affecting the treatment of people with lung cancer. Surgeries have been the most impacted lung cancer treatments, with many individuals having their operations delayed during the pandemic.11 Other people, meanwhile, have needed to switch to a different medication.12 Lockdown restrictions have also presented a challenge in maintaining access to treatments throughout the pandemic.13
Dr Anne-Marie Baird added that, “For a lot of people with lung cancer, their best option would be to take part in a clinical trial. As a result of the pandemic, people with lung cancer may have had to change treatment and therefore may no longer be eligible to participate in certain trials.” She hopes that clinical trial recruitment will become more flexible and “that people impacted by the pandemic can still participate.”
These challenges are not only faced by people reliant on medicines now, but also impact the research and development of medicines in the future. We need to make sure we continue vital research to be able to continue helping people impacted by this disease.
Since people with lung cancer are particularly vulnerable to developing more severe complications from COVID-19, it is also important to make sure that there is a strong support system in place to diagnose and manage the impact of COVID-19 on people who contract the virus.14
It is crucial that the challenges mentioned above are urgently addressed because of the long-term impact on the survival of people impacted by this disease. It’s estimated that, as a result of COVID-19, five-year survival for people with lung cancer in the UK may fall from 16.2% in 2017 to 15.4% in 2020.15
Turning challenges into opportunities
While there have been and continue to be many challenges, healthcare systems, governments and other parties within the lung cancer community have been quick to adapt. For example, with many people unable to visit a clinic for intravenous drug administration, some healthcare providers have changed medications to those that can be taken at home.12 During the pandemic, some countries have also established mobile liquid biopsy services that can detect genomic alteration, performed in the people’s homes or special clinics, minimising the risk of infections.
Technology and telemedicine have stepped in to provide opportunities for people living with the disease and their healthcare professionals to follow up virtually on recent treatments and get a diagnosis or referral, without the potential added risk of traveling to a healthcare centre.10 At Roche, we are focused on solutions to support clinical decisions which enable clinicians to access all the materials they need remotely to make an informed diagnosis decision and decide on treatment pathways.
While a lot of effort is dedicated to mitigating the impact of these challenges, it requires further collaboration, refinement and investment for tools to work most effectively.
We are committed to working with healthcare partners to find the best solutions for people impacted by the disease as well as providing the best support for people currently enrolled in clinical trials. This includes improved at-home support, mobile infusion centres and home infusion, as well as more flexible involvement in clinical trials to participants and expanding the collaboration with telehealth and technology companies. Working together with all stakeholders is key in addressing the challenges along the patient journey, by co-creating impactful tailored integrated and flexible care solutions.
The challenges in lung cancer diagnosis and access to treatment presented by COVID-19, are not new but have become more pronounced through the pandemic. This is a moment in time to put our healthcare systems and processes under the microscope and work together to find the best solutions for lung cancer patients.
Maintaining our focus
At Roche, lung cancer has been a focus for decades and we are pioneering a 360˚ approach by combining new tests, treatments and access solutions. This comprehensive approach aims to both individualise and transform the care continuum and outcomes for people with lung cancer, by offering personalised treatments fitted to people’s unique needs.
Throughout the COVID-19 pandemic, we have been committed to continuing research, so we can continue to advance the treatment options available to people with lung cancer.”
“We have six approved medicines and an extensive pipeline across multiple subtypes to address the multifaceted nature of lung cancer, developed by a powerhouse of highly dedicated scientists and clinicians,” said Sushil Patel, Franchise Head for Lung, Agnostic, Skin & Rare Cancers (LASR) at Roche.
“One of our focus areas is understanding driver mutations in lung cancer through personalised treatment, which complements the efforts of our diagnostics teams to continuously look for new ways to improve testing so that people can receive the treatment that is right for their specific tumour type. All this with an ultimate aim of providing an effective treatment option for every person diagnosed with the disease. Now more than ever it is critical that the progress achieved to date is not compromised and despite the challenges COVID-19 presents, we must ensure continuity of access to our medicines to patients and keep them at the heart of everything we do.”
Looking to the future
The future starts now. While there are still so many unknowns about the global impact of COVID-19, we do know that the pandemic has had a vast impact on the lives of people with lung cancer. To ensure that we advance the positive progress that has been made so far, we must continue focusing our efforts on removing barriers to lung cancer diagnosis, testing and treatment. It is critical that every person can confidently identify signs of lung cancer, and that if something feels “off,” that they don’t wait to contact their physician.
We are living in unprecedented times and we cannot be certain how long the pandemic will continue to impact us all. One thing we can be certain of, is that we will continue to work together as a community, to find solutions to the challenges facing people with lung cancer in this ever-changing landscape, now and in the future.
- Cancer Research UK. News digest – calorie guidelines, reduced lung cancer referrals and COVID-19’s impact on cancer services. [Internet; cited November 2020]. Available from: https://scienceblog.cancerresearchuk.org/2020/09/19/news-digest-calorie-guidelines-reduced-lung-cancer-referrals-and-covid-19s-impact-on-cancer-services/
- Cancer Research UK. Lung cancer risks becoming ‘forgotten disease’ of the coronavirus pandemic. [Internet; cited November 2020]. Available from: https://www.cancerresearchuk.org/about-us/cancer-news/news-report/2020-09-17-lung-cancer-risks-becoming-forgotten-disease-of-the-coronavirus-pandemic
- National Institutes of Health. New treatments spur sharp reduction in lung cancer mortality rate. [Internet; cited November 2020]. Available from: https://www.nih.gov/news-events/news-releases/new-treatments-spur-sharp-reduction-lung-cancer-mortality-rate
- UK Lung Cancer Coalition. COVID-19 Matters: A review of the impact of lung cancer pathway and opportunities for innovation emerging from the health system response to the pandemic. [Internet; cited November 2020]. Available from: https://www.uklcc.org.uk/wp-content/uploads/2020/10/UKLCC-COVID-19-Matters-Report-Oct-2020.pdf
- World Health Organization. Cancer. [Internet; cited November 2020]. Available from: https://www.who.int/news-room/fact-sheets/detail/cancer
- Global Lung Cancer Coalition. Patient Charter. [Internet; cited November 2020]. Available from: http://www.lungcancercoalition.org/patient-charter.html
- BBC. Why most Covid-19 deaths won’t be from the virus. [Internet; cited November 2020]. Available from: https://www.bbc.com/future/article/20200528-why-most-covid-19-deaths-wont-be-from-the-virus
- Cancer Australia. Investigating symptoms of lung cancer: a guide for all health professionals. [Internet; cited November 2020]. Available from: https://www.canceraustralia.gov.au/ISLCGuide
- Roche. COVID-19 and Cancer: Expert Panel Discussion and Q&A [Internet; cited November 2020]. Available from: https://www.youtube.com/watch?v=i3H2FpTZkoE
- Mayo Clinic. COVID-19 Accelerates Telemedicine Use in Oncology Practices. [Internet; cited November 2020]. Available from: https://www.mayo.edu/research/forefront/covid-19-accelerates-telemedicine-use-in-oncology-practices
- Sud A., Jones M.E., Broggio J., et al. Collateral damage: the impact on outcomes from cancer surgery of the COVID-19 pandemic. Annals of Oncology. 2020:31(8);1065-74.
- NHS England. NHS England interim treatment options during the COVID-19 pandemic. [Internet; cited November 2020]. Available from: https://www.nice.org.uk/guidance/ng161/resources/interim-treatment-change-options-during-the-covid19-pandemic-endorsed-by-nhs-england-pdf-8715724381
- Center for Global Development. Understanding the Impact Of COVID-19 On Essential Medicine Supply Chains. [Internet; cited November 2020]. Available from: https://www.cgdev.org/blog/understanding-impact-covid-19-essential-medicine-supply-chains
- Lung Cancer Research Foundation. COVID-19 and Lung Cancer. [Internet; cited November 2020]. Available from: https://www.lungcancerresearchfoundation.org/lung-cancer-groups-issue-statement-on-coronavirus/
- IPPR. The hidden cost of Covid-19 on the NHS - and how to ‘build back better’. [Internet; cited November 2020]. Available from: https://www.ippr.org/blog/the-hidden-cost-of-covid-19-on-the-nhs