Safer Infusion Treatments for Cancer During the Pandemic

How to Mitigate Risks Posed by COVID-19, Improve Outcomes
Safer Infusion Treatments for Cancer During the Pandemic
COMMENTARY
December 15, 2020
Senior Vice President, CVS Health and Chief Medical Officer, CVS Caremark

A diagnosis of cancer — and effectively managing the condition — is challenging at the best of times. The COVID-19 pandemic has made it much more so.

The shutdowns and stay-at-home orders, as well as overburdened health care resources, could cause delays in diagnosis. What’s more, in April, the Centers for Medicare & Medicaid Services classified screening as a low-priority service and suggested health care organizations consider postponing screenings.https://www.cms.gov/files/document/cms-non-emergent-elective-medical-recommendations.pdf.

woman wearing red shirt with spyglassCancer screenings and diagnoses declined in April through May 2020 due to COVID-19 pandemic control efforts:

~89%

breast cancer screeningshttps://www.cancernetwork.com/view/delay-in-cancer-screening-and-diagnosis-during-the-covid-19-pandemic-what-is-the-cost.

~84%

colorectal cancer screeningshttps://www.cancernetwork.com/view/delay-in-cancer-screening-and-diagnosis-during-the-covid-19-pandemic-what-is-the-cost.

~65%

new cancer screenings

~89%

breast cancer screenings2

~84%

colorectal cancer screenings3

~65%

new cancer screenings

These measures led to delays in screenings and, therefore, diagnosis. Standard screenings for breast cancer dropped by 89.2 percent while those for colorectal cancer dropped by 84.5 percent through May 2020.https://www.cancernetwork.com/view/delay-in-cancer-screening-and-diagnosis-during-the-covid-19-pandemic-what-is-the-cost. These pandemic control efforts translated to a significant decline in the number of new cancer diagnoses, resulting in a decrease of 65.2 percent of new cancer diagnoses in April 2020. Delays in diagnosis could mean poorer outcomes because patients don’t get timely treatment.

Higher Mortality Risk for Cancer Patients

The novel coronavirus also poses unique risks for cancer patients. Research in the United Kingdom and Spain have shown a higher mortality rate among cancer patients who contract COVID-19.https://www.cidrap.umn.edu/news-perspective/2020/05/studies-highlight-covid-19-impact-cancer-patients. In Spain, 13 percent of patients died, while in the UK, 28 percent died within 30 days of diagnosis. Research presented at the COVID-19 and Cancer Consortium showed that patients with progressing cancer were at 5.2 times higher risk of dying as a result of a COVID-19 infection than those in remission or with no evidence of the disease.https://ascopost.com/issues/june-10-2020/patients-with-cancer-especially-progressive-disease-infected-with-covid-19-may-have-an-increased-risk-of-death/.

Just being treated for cancer, or the kind of treatment they were receiving, did not appear to raise their mortality risk. However, given that cancer patients are typically older and immunosuppressed, the study results do indicate that ensuring patients can safely access therapies such as infusion treatments is critical to protecting them from getting infected.

Receiving infusion treatment in an in-patient setting, a cancer care clinic, or a doctor’s office, such care can be less convenient and potentially higher risk. Patients often have to drive to a site in an urban setting to receive their treatment, and they typically have to wait in a room with other patients, which could increase their risk of being infected by COVID-19.

COVID-19 impact on cancer care:

33%

chemotherapy treatmentshttps://avalere.com/press-releases/decline-in-oncology-and-immunology-treatment-amid-covid-19-pandemic.

56%

other immunotherapieshttps://avalere.com/press-releases/decline-in-oncology-and-immunology-treatment-amid-covid-19-pandemic.

COVID-19 impact on cancer care:

33%

chemotherapy treatments7

56%

other immunotherapies8

The higher risks faced by cancer patients during this time have had a profound impact on them accessing care. In April alone, there was a 33 percent drop in chemotherapy treatments and a 56 percent decline in the administration of other immunotherapies.https://avalere.com/press-releases/decline-in-oncology-and-immunology-treatment-amid-covid-19-pandemic.

Safer Infusion Options for Better Outcomes

Uninterrupted treatment is a critical component of effectively managing cancer. The unique risks posed by COVID-19 dictate that we find safer ways to ensure continuity of care. For instance, patients with cancer on certain oral and infused immunotherapies could be transitioned to an at-home setting to help improve access and therefore, outcomes. At-home treatments could not only reduce their risk of exposure, but also offer more scheduling flexibility while keeping them adherent to their treatment regimen. Research shows that at-home infusion treatments can also be significantly lower cost than infusions in other medical settings.https://www.sciencedirect.com/science/article/pii/S2213076415300555.

Transitioning patients who have been stable on their immunotherapy for a period of time and have not had any significant adverse events can also help free-up capacity within the health care system for other patients and acute needs.

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COMMENTARY
December 15, 2020
Senior Vice President, CVS Health and Chief Medical Officer, CVS Caremark

Data source, unless noted otherwise, CVS Health Enterprise Analytics, 2020.

Image source: Licensed from Getty Images, 2020.

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