Barriers to Access for COVID-19 Treatments Put Patients With Cancer at Risk

John M. Burke, MD

There has been welcome news recently in the field of treatments for COVID-19. Amid the surge of the omicron variant, the FDA issued an emergency use authorization for the orally administered antiviral combination of nirmatrelvir/ritonavir (Paxlovid), which, when initiated within 5 days of symptom onset, reduced the rate of hospitalization or death by 88%. Similarly, a 3-day course of intravenously administered remdesivir (Veklury) was shown to reduce the rate of hospitalization or death in outpatients by 87% compared with placebo.

One would hope that the utilization of these new tools, plus the vaccines that were previously developed and made available, would markedly reduce the death toll that SARS-CoV-2 has infl icted upon the world and, disproportionately, our patients with malignancies and suppressed immune systems. Perhaps such a reduction in the death toll will occur soon.

Early in the pandemic, I could count exactly how many patients I had lost to COVID-19. After the first 8 to 9 months of the pandemic, that number was about 15 patients. I could even name each one of them for a while. After that, I began to lose count. My best guess is that the number is somewhere between 40 and 50. I can no longer list every patient by memory. This past month alone, I lost 3 more patients to COVID-19. In fact, I suspect that I’ve lost many more patients to COVID-19 in the past 2 years than I have to cancer itself.

We need to get these new treatments out to our patients quickly. The rollout and availability of these treatments have been spotty. For example, although tixagevimab/cilgavimab was given emergency use authorization on December 8, 2021, I first got access to it on February 1, 2022. In talking to colleagues around the country, some of them have had access to it, whereas others have not. Obtaining nirmatrelvir/ritonavir has not been simple either. Where I practice in Colorado, it has been made available only through hospital pharmacies but not through commercial pharmacies. Some of these hospital pharmacies have run out of the medication quickly, and guidance for physicians on how to obtain it has been lacking. And where better to give 3 daily doses of intravenous remdesivir than the oncology clinic, where infusions are given all day every day? At this point, my patients have been able to access remdesivir only in the inpatient setting, not in the outpatient setting, where it probably works best. Making these effective treatments more readily available in local pharmacies and infusion centers will go a long way toward reducing the frequency, severity, and death toll of COVID-19—a goal that has been a long time coming.