With new cancer diagnoses down by 37% since the onset of the COVID-19 pandemic, and data from IQVIA showing that 22 million people postponed cancer screening tests and 80,000 patients delayed or missed diagnoses, America’s comprehensive cancer centers and integrated delivery networks (IDNs) are anticipating a major “shadow curve” in new cancer cases in the months and year to come.
In a July webcast sponsored by the Association for Value-Based Cancer Care (AVBCC), leaders from several of these programs discussed how to meet this impending tsunami of need, as well as other major challenges, such as reinvigorating cancer research, that have been interrupted by the pandemic.
Cancer Treatment Centers of America (CTCA) has established new policies to make visits easier and safer for new patients, said CTCA’s Chief Medical Officer Julian Schink, MD. “Via telehealth, we have established a ‘visit zero’—an introductory visit for new patients before they ever come into one of our facilities. We talk about their needs, collect data, and figure out what testing and scans they might require. It makes us more efficient, and decreases traffic and waiting times within the hospital and treatment areas.”
Patients can’t be more afraid of COVID-19 than of cancer, cautioned Timothy Kubal, MD, MBA, Medical Director of Process Excellence, Moffitt Cancer Center, Tampa, FL.
“That’s trouble too—just slightly later trouble. We originally saw our volume slam down, by design, but now we have climbed back up for both established and new patients. Our treatment visits are almost on par with where they were before, and screening volumes are growing,” Dr Kubal said.
But, he added, during the “COVID-19 reset,” he noticed an interesting phenomenon. As a hematologist, he had many patients who did not want to come to the clinic to get laboratory testing and meet with him. Instead, he advised them to get their tests taken at a location near their home and discuss the results via telemedicine. “Even now, 100% of patients prefer that option to coming in,” he said. “After people have had this experience, they are starting to define value differently.”
For the small-to-midsized IDNs that make up the Association of Community Cancer Centers’ (ACCC) membership, most of whose patients are either covered by Medicare, Medicaid, or are dual eligible, revenue has declined as it has at other centers, but they are less able to spread the pain around, said ACCC’s Executive Director Christian Downs, MHA, JD.
“They are also struggling with staffing, but don’t have as many to draw from, and many of their patients are financially struggling. Stimulus money is starting to flow into the system and is helping the IDNs overall, which is a good thing, and surgery, radiation, and other outpatient services are starting to come back. But realistically, the road to recovery will be slow,” Mr Downs said.
ACCC has archived a series of webinars, podcasts, and other resources on its website (http://www.accc-cancer.org/home/news-media/coronavirus-response). Originally developed when the pandemic was hitting the Northeast, Mr Downs says these resources will continue to be relevant as hotspots roll across the country.
Academic medical centers and the cancer research enterprise in general have taken a major hit, said Al B. Benson III, MD, FACP, FASCO, Professor of Medicine and Associate Director for Clinical Investigations, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL.
“In training programs, graduate students weren’t able to go to their labs and many experiments had to shut down,” he said. “They’re on a timeline, and this has had a major effect on their training and their work. They will have to problem-solve how to make up for the lost time, how to recover experiments, and work with their funding mechanisms,” Dr Benson said. “On the clinical side, we have had similar issues with our medical students and residents that directly affected their training. Our teaching services at Northwestern are now back to full operation, but everyone is concerned that with Fall coming up, it might happen again. How are we going to accommodate and shift schedules to make an environment where it’s safe for trainees to pursue their educational goals?”
The American Society of Clinical Oncology (ASCO) has launched a “Road to Recovery Task Force” for practice and research, said ASCO’s Immediate Past President Howard A. “Skip” Burris III, MD, FACP, FASCO, President, Clinical Operations, and Chief Medical Officer, Sarah Cannon, Nashville, TN.
“There had been a big decline in phase 2 and 3 accrual initially, but that seems to be recovering,” he said. “What we need to do in our new normal is modernize the clinical trials process and get it closer to home, so our patients have to travel less,” Dr Burris recommended.