Though the COVID-19 pandemic continues to upend our day-to-day lives, we are just beginning to understand its long-term repercussions. At the world’s largest scientific conference dedicated to breast cancer, the San Antonio Breast Cancer Symposium, a panel of researchers and patient advocates addressed the pandemic’s impact on breast cancer treatment, patient health and quality of life, and systemic disparities in diagnosis and care.
Session participants reflected diverse racial, ethnic, geographic, and socioeconomic backgrounds, and all of them stressed the importance of getting vaccinated and continuing breast cancer screening and treatment when feasible.
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Dr. Peter Jay Hotez of Baylor College of Medicine echoed this sentiment in an overview of where we are in the pandemic nationally and globally. Specifically addressing questions on breast cancer care, he discussed the complications patients still face when navigating treatment decisions, even with widely available vaccines and boosters that allowed many people to return to normal life—or closer to it. Those who are taking immunosuppressive therapies, for example, may not get maximum protection after inoculation.
“Working closely with your oncologist is absolutely critical to understanding [your situation],” Dr. Hotez said.
COVID-19’s impact on cancer center operations is expected to be long-lived. Delays in screenings, biopsies, and cancer-related surgeries are expected to lead to later-stage diagnoses for years to come. Staff shortages, COVID-19 restrictions and protocols, as well as interruptions in the global supply chain have increased stress and anxiety for patients and staff. These factors have exacerbated existing shortages—a problem that will not turn around quickly.
Yet in spite of these very real challenges, COVID-19 has forced clinics to adopt new practices—many of which are likely to be in use for the long-term, including telehealth medicine and virtual patient support, most notably.
While telehealth isn’t new, the pandemic forced a widespread use of virtual services throughout oncology care. Now, many patients are receiving nutrition and financial counseling, patient navigation services, access to support groups, symptom monitoring, and psychological support online. In select patient surveys, telehealth was generally accepted, and respondents felt it improved health care access and saved time and money.
Still, there are limitations, particularly when patients have limited access to technology or internet. These patients are more likely to be older, Black, or from rural communities.
“The pandemic has forced cancer care to continue to evolve as we support patients where they are,” Dr. Debra Patt of Texas Oncology said.
COVID-19 has been a catalyst in other ways as well, including changing how clinical trials are conducted and how important research results can reach a larger population.
Broadening clinical trial eligibility criteria and decentralizing clinical trials have long been priorities among breast cancer patients—especially those with metastatic/stage IV disease. COVID-19 has forced investigators to adapt how clinical evidence or real-world data (that which is collected during routine clinical care) is assembled.
In contrast to data from clinical trials that is highly controlled with strict eligibility criteria, real-world data is obtained from routine clinical care assessments and include electronic medical records, Medicare or insurance claims, and other patient generated health data—all information that captures the experiences of a broad patient population. Used in conjunction with randomized clinical trials, real-world data adds to the level of evidence that can then influence patient care.
Such data has also provided an opportunity to effectively and economically evaluate systems and strategies that were rapidly implemented in response to the pandemic. Moreover, it is enabling ongoing monitoring of cancer patients who have survived COVID-19 to understand long-term impacts of infection on this population. Thus, the collection of real-world data, along with carefully designed clinical studies, will be important in realizing the full repercussions of the pandemic on cancer care.
“There are silver linings…that I think will serve us for decades to come, and, in this way, the COVID pandemic has been a catalyst to improve [breast cancer] care delivery,” Dr. Pratt said.
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