A New Approach to Fighting Cancer

The coronavirus is our newest global health threat, but it’s also had grave effects on one of our oldest: cancer. The ongoing pandemic has prevented or deterred many from seeking cancer care, wreaking incalculable damage. As mass vaccinations help to curb the COVID-19 crisis, we must urgently expand public health efforts to address the mounting impact of cancer. We can do this by combining new technology with targeted efforts to ensure equitable access to care.

People living with cancer or undergoing chemotherapy most likely have had their immune systems compromised. That means they’re more vulnerable to COVID-19 infection, and may have worse outcomes when they do contract the disease. Fear of the virus has kept many cancer patients (and many in the general public) out of doctor’s offices and hospitals during the pandemic, causing widespread postponement of screenings, surgeries and routine care.

Estimates of the collateral damage are dire: According to the World Health Organization, half of governments have reported that cancer services were “partially or completely disrupted because of the pandemic,” and the problem cuts across all income levels. Prior to the pandemic, the global cost of cancer was estimated at $1.6 trillion annually. That figure will likely skyrocket.

We urgently need to get this situation under control – and with a smart strategy combining technological innovation and appropriate outreach, we can. The first step is to deploy new technologies that enable health care providers to understand and adjust for the different risk profiles of cancer patients.

For instance, it has been documented that lung cancer patients are especially vulnerable to poorer outcomes if they have COVID-19. Rapid analysis of real-world data from multiple lung cancer registries over the past year has provided substantial information on the effects of different treatments approaches in lung cancer patients with COVID-19 and enabled recommendations to be made the goal of improving outcomes. Understanding these factors allows health care professionals in some cases to provide patients with more confidence that it is safe to return to the clinic.

In other cancers, less invasive approaches that can be done at home may be able to be prioritized and implemented. This can relieve some of the pressure on specialists and clinical staff already stretched thin. It also serves as a safe way for patients still concerned about coronavirus infection to seek screening consultations, in order to catch cancers as early as possible.

Some recent breakthroughs are enabling this shift. For example, we now have a home-testing option for colon cancer, the fecal immunochemical test. Other non-invasive techniques such as liquid biopsies (that can identify evidence of tumors and biomarkers through blood tests) could hold promise to provide options that help people avoid hospital visits. In 2020, the pan-Canadian Digital Technology Supercluster (of which Novartis is a partner) launched a broad liquid biopsy program in Canada to eliminate the need for patients to travel to hospitals for surgical biopsies.

The second step is ensuring equitable access to care. The pandemic exacerbates multiple factors that can impact motivation or ability to seek cancer screening and treatment in underserved populations, such as work furloughs, reduced public transportation or an essential worker’s fear of getting sick and losing a paycheck. Our strategy to repair the collateral damage caused by the coronavirus must take this dynamic into account. For example, at Novartis we have worked with physicians and pharmacies to have trial medicines delivered to patients’ homes and to try to transition clinical trial visits to local physicians to reduce pressure on patients.

Furthermore, we must address health disparities among disadvantaged communities. In the United States, Black Americans have the highest rates of colon cancer and related deaths. Using patient navigators at the point-of-care to promote access to screening can increase participation. A patient navigator program in Delaware increased colon cancer screening rates for Black Americans to the same level as for white patients, while reducing late-stage diagnosis by 39 percent.

In low-income countries, we can combine these steps to make big gains. For example, hyperfractionated radiotherapy delivers radiation treatments in smaller doses more than once a day, enabling fewer treatment sessions, using fewer resources, and with a cost that’s half of the standard radiation therapy.

As the pandemic took hold, several health systems began using this approach to relieve pressure on their imaging resources. They could continue to do so even when the pandemic subsides, with appropriate technical training. If this technique were adopted throughout Africa, the potential savings over seven years would be $1.1 billion for breast cancer and $606 million for prostate cancer.

COVID-19 has had a huge impact in the fight against cancer. By embracing innovation and ensuring equitable access, we can help close the gaps in patient care and reorient health systems to improve screening and early detection of cancers.

Amy Israel is vice president and global head, Oncology Policy & Healthcare Systems, Novartis.

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