The pandemic has also triggered a shift to telemedicine wherever possible, Dr Owonikoko explained. For some patients, “we don’t see them in person; we do telehealth visits with video conferencing to help minimize the [infection] risk,” he said. While prior to the pandemic, some clinicians expressed doubts about the benefits of telemedicine over in-person visits, the pandemic has brought a realization that “there are occasions where the video visit would just be sufficient for the purpose for which the visit was scheduled,” he said. Particularly for patients who have to travel long distances for appointments, “I hope that becomes part of our way of caring for patients on a permanent basis going forward.”

To Dr Higgins, a particularly worrying impact of the pandemic has been the effect on lung cancer clinical trials, which are sometimes the best option for certain patients to receive treatment. Many trials stopped, or reduced, the enrollment of new patients, she explained. Although clinical trial enrollment has recovered to some extent, the long-term impact of COVID-19 remains a cause for concern. “That could slow the pace of discovery of new therapies that become available to our patients,” she said. “I hope that it will self-correct [and] . . . that we don’t see delays in progress down the road — that could be a potential downstream effect of the pandemic.”

The long-term impacts of the pandemic’s disruptions across lung cancer care — from trials and treatments, to screening and diagnosis — are still unclear, but studies are under way to gain insight. One such trial is the Lung Radiotherapy during COVID-19 (COVID-RT Lung) project launched by the University of Manchester in the United Kingdom.11 COVID-RT Lung is currently assessing how many clinics have altered radiotherapy treatment during the pandemic and the impact on clinical outcomes, explained research project manager Kate Wicks, PhD, from the Division of Cancer Sciences at the University of Manchester.12 “Our study will demonstrate whether the changes in radiotherapy treatments during the pandemic have [influenced] side effects and chances of controlling both the cancer and survival,” she explained.

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Dr Owonikoko said he hopes to soon start comparing outcomes for cancer patients treated during the COVID-19 pandemic against those treated before its onset last year, and will investigate whether current treatment trends return to baseline levels after the pandemic has subsided. “Those are valid research questions that will have to be answered, but those are questions for the future, not while we’re still within the pandemic.”

Disclosures: Some of the authors of the publications discussed reported financial ties to the pharmaceutical industry. For a full list of disclosures, please refer to the original references. 

References

  1. Van Haren RM, Delman AM, Turner KM et al. Impact of the COVID-19 pandemic on lung cancer screening program and subsequent lung cancer. J Am Coll Surg. Published online December 17, 2020. doi:10.1016/j.jamcollsurg.2020.12.002
  2. Reyes R, López-Castro R, Auclin E et al. Impact of COVID-19 Pandemic in the Diagnosis and Prognosis of Lung Cancer. J Thorac Oncol. Published online March 19, 2021. doi:10.1016/j.jtho.2021.01.219
  3. Cancer Research UK. GPs report ‘perfect storm’ of problems leading to 20,000 drop in urgent referrals for lung cancer. Published March 24, 2021. Accessed April 19, 2021.
  4. Garassino MC, Whisenant JG, Huang L-C, et al. COVID-19 in patients with thoracic malignancies (TERAVOLT): first results of an international, registry-based, cohort study. Lancet Oncol. Published online June 12, 2020. doi:10.1016/S1470-2045(20)30314-4
  5. Dai M, Liu D, Liu M, et al. Patients with cancer appear more vulnerable to SARS-CoV-2: a multicenter study during the COVID-19 outbreak. Cancer Discov. Published online April 28, 2020. doi:10.1158/2159-8290.CD-20-0422
  6. American College of Surgeons. COVID-19 guidelines for triage of thoracic patients. Published March 24, 2020. Accessed April 21, 2021.
  7. Guckenberger M, Belka C, Bezjak A, et al. Practice recommendations for lung cancer radiotherapy during the COVID-19 pandemic: an ESTRO/ASTRO consensus statement. Radiother Oncol. Published online April 6, 2020. doi:10.1016/j.radonc.2020.04.001
  8. Faivre-Finn C, Fenwick JD, Franks KN, et al. Reduced fractionation in lung cancer patients treated with curative-intent radiotherapy during the COVID-19 pandemic. Clin Oncol (R Coll Radiol). Published online May 13, 2020. doi:10.1016/j.clon.2020.05.001
  9. Elkrief A, Kazandjian S, Bouganim N. Changes in lung cancer treatment as a result of the coronavirus disease 2019 pandemic. JAMA Oncol. Published online May 13, 2020. doi:10.1001/jamaoncol.2020.4408
  10. European Society for Medical Oncology (ESMO). ESMO management and treatment adapted recommendations in the COVID-19 era: lung cancer. Accessed April 19, 2021.
  11. Manchester Biomedical Research Centre, National Institute for Health Research. Manchester launches national project to understand changes in radiotherapy treatment for lung cancer patients during COVID-19. Published October 22, 2020. Accessed April 19, 2021.

Topics:

COVID19 Lung Cancer