Clinical guidance may impact cancer treatment rates during COVID-19
medwireNews: The number of people initiating systemic cancer therapies fell substantially at the start of the COVID-19 pandemic but then recovered rapidly with the implementation of new treatment guidance, UK study data show.
James Clark (Imperial College London) and colleagues reviewed data from a central National Health Service England database to determine the monthly number of new systemic cancer treatment registrations in April, May, and June 2020.
They report in The Lancet Oncology that in April 2020 there were 2969 registrations recorded, which was 1417 fewer than the monthly mean for the control period of September 2019 to February 2020, representing a significant 32% reduction and an absolute difference of 4.2 standard deviation units (SDs).
Clark and team note that in April and May 2020 “the NHS implemented additional and specific treatment options […] to mitigate the risk of COVID19 in patients requiring systemic anticancer treatment.” These included oral drug alternatives and the earlier use of less immunosuppressive drugs normally only licensed for use later in the treatment pathway.
The researchers say that as a likely result of this and other risk mitigation factors (such as telephone consultations, facemasks, and physical distancing), the number of registrations increased to 3950 in May 2020, but were still a significant 10% lower than during the control period, with an absolute difference of 1.3 SDs.
In June 2020, the number of registrations increased further to 5022, which was a significant 15% and 1.9 SDs higher than during the control period.
Clark and colleagues found that the majority (81%) of additional registrations that occurred in May 2020 were for COVID19specific drug indications.
In addition, they observed that the pattern of an initial decrease in numbers followed by subsequent recovery was consistent across the majority of intents of therapy, tumor types, lines of noncurative therapy, and modes of administration.
However, the number of registrations for neoadjuvant therapies, chronic lymphocytic leukemia, and follicular lymphoma and Waldenström macroglobulinemia remained significantly lower in June 2020 compared with the control period.
Among the four most common solid tumors, new registrations were a significant 57%, 36%, 33%, and 32% lower for prostate, lung, breast, and skin cancer, respectively, in April 2020 versus the control period. In June 2020, the number of registrations for prostate and lung cancer were a significant 83% and 22% higher than during the control period, whereas those for breast and skin cancer had returned to expected levels.
Clark et al conclude that their findings “can provide some reassurance to patients and clinicians that treatment delays can be minimised or avoided if health-care providers are able to quickly implement guidance on drug prescribing.”
They add: “The impact of not prescribing or delaying systemic anticancer treatment on patient outcomes needs to be monitored in the forthcoming months, especially for non-curative therapies used for advanced disease (some of which only extend survival by a few months), and for neoadjuvant treatment.”
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