Cancer Care Resilience After COVID-19: Plans and Initiatives from ASCO

Only weeks after the coronavirus disease 2019 (COVID-19) pandemic began, 60% of research programs reported that they had halted screening and/or the enrollment of patients to some clinical trials, according to a report from the American Cancer Society of Oncology (ASCO) and the Association for Clinical Oncology, an affiliate association of ASCO.

Parallel to the results of this survey, ASCO also announced their plans and upcoming initiatives for improving cancer care in the post-COVID-19 setting. Their plans include the development of multidisciplinary workgroups to evaluate policies and best practices learned from the pandemic.

“While we’re in very tough times, this crisis presents an opportunity to improve the quality and resiliency of cancer care,” said Howard A. “Skip” Burris, III, MD, FACP, FASCO, president, ASCO, in a statement. “To maximize that potential, we’ll be drawing on the expertise of the full cancer community, action by policymakers, and data to proactively transition to post-crisis cancer care and achieve the best outcomes for patients in the months and years ahead.”

Over two-thirds of survey respondents use remote visits in place of clinical trials. However, research sites face challenges in optimizing telehealth in their institutions. A decline in the ability or willingness of patients to come on-site was also reported.

Oncology researchers should evaluate the impact of trial protocol modifications, like expansion or flexibility of timelines and reductions in data collection requirements, to determine if the studies can be safely and successfully continued once the COVID-19 pandemic comes to an end, according to David Waterhouse, MD, MPH, et al, authors of the report. Other modifications, such as acceleration of patient enrollment, should be evaluated.

The authors announced an advocacy agenda for Congress and the Administration as bold policy actions are essential at the federal level. The proposed agenda explains 8 policy changes that are required for the sustainability of high-quality cancer care through the remainder of the pandemic. The changes will also help in planning for the future following the end of the global crisis.

These recommendations include continued support for telehealth, additional and immediate financial support for practices, the passage of federal oral parity legislation, and prevention of additional drug shortages.

Centers for Medicare & Medicaid Services, as well as private payers, are urged to reimburse audio-only visits fully under these recommendations. Additional financial support is also required, despite funds many oncology practices are receiving through the CARES Act.

The authors also noted that Congress should require oral cancer treatments to be reimbursed at comparable levels to intravenous (IV) chemotherapy as these medications can be taken orally at home to reduce the risk of exposure to COVID-19. In Congress’s next COVID-19 relief package, the authors recommend Congress include The Cancer Drug Parity Act to prohibit the current unequal cost-sharing between oral and IV medications.

In an effort to prevent additional shortages of drugs, the authors recommend an aggressive action plan to mitigate these shortages and to include the “whole-of-government” approach across federal agencies. This includes constant awareness of potential supply chain disruptions, as well as contingency plans to help mitigate acute shortages of medications.

ASCO announced its “Road to Recovery” initiative in recognition of upcoming challenges expected in re-establishing cancer care and research after the pandemic ends. The initiative will include education on the lessons that practices have learned in the current challenging environment set forth by the pandemic.

Two multidisciplinary workgroups, which will include patients, patient advocates, and experts in surgery, medical oncology, radiation oncology, oncology nursing, supportive care, clinical research, and practice administration, will convene to map out a plan for returning to the new “normal” following the conclusion of the COVID-19 pandemic. These workgroups will evaluate how the changes in cancer care delivery, as well as research, may inform new approaches for delivering high-quality care moving forward.

The workgroups are also tasked with developing a blueprint of recommendations for policies and practices that are essential for supporting recovery following the pandemic.

ASCO also launched the ASCO Survey on COVID-19 in Oncology Registry, which is also known as the ASCO Registry. This aims to improve learning among the cancer community regarding patterns of symptoms and the severity of COVID-19 among patients with cancer. It also aims to highlight how the disease is impacting the delivery of care to patients with cancer and their outcomes.

The ASCO Registry will collect both baseline and longitudinal data to determine how the virus is impacting cancer care during the pandemic in 2020 and into 2021.

_Reference

_{New Clinical Trial Data, Initiatives, and Path Froward for Post-COVID-19 Cancer Care Delivery System Announced [news release]. Alexandria, VA: ASCO; April 23, 2020. https://bit.ly/2VOBlkM. Accessed April 24, 2020.}