Changes in systemic cancer treatment in Australia during the COVID-19 pandemic: a population-based study

CONTEXT RESEARCH

The spread of the COVID-19 pandemic in Australia has resulted in closures, changes in health services and the formulation of consensus guidelines to guide risk management for people with cancer. The impact of these changes on cancer care and outcomes has raised concerns. Although cancer registry data shows a reduction in cancer diagnoses in Australia from April to October 2020, it is not known whether systemic cancer therapy has changed significantly in the context of the pandemic.

We identified existing Medline studies published from 1996 to present using keyword search (“impact of COVID-19 on cancer”), (“COVID-19” OR “SARS-CoV- 2 “) AND (” cancer “OR” oncology “) AND (” chemotherapy “OR” immunotherapy). Data from England demonstrate a substantial reduction in the initiation of all types of systemic cancer therapies at the onset of the pandemic, with a return to normal levels by June 2020. There have been notable reductions in neoadjuvant therapies and non-curative chemotherapy, as well as immunotherapy. A report from Scotland indicated fewer dating for systemic cancer therapy from March to April 2020 compared to previous years. Population-based data from England and Northern Ireland revealed a significant decrease in urgent referrals for chemotherapy and chemotherapy consultations at the start of the COVID-19 pandemic. Retrospective studies of cancer patients receiving intravenous cancer treatment in New York City hospitals found that about half of the patients had undergone treatment changes. These reports contrast with the results from New Zealand, where the number of chemotherapy visits has not changed despite reductions in cancer registrations and diagnostic procedures in 2020. Reports based on surveys suggest that changes in the Standard treatments have been instituted by cancer clinicians in Australia and abroad. However, the quality of this evidence is low because it reflects the opinions of respondents, and not verified changes in treatment.

We found a systematic review of delays and disruptions in cancer healthcare during the COVID-19 pandemic. This identified 62 relevant studies, but none were of high methodological quality and few were linked to changes in systemic cancer treatment. Again, many of the reports were based on surveys of staff or centers rather than primary data. This indicates a lack of evidence in this area.

Added value of this study

To our knowledge, this is the first analysis of national person-level data on cancer drug use during the COVID-19 pandemic. Our Australian data allowed us to determine whether specific recommendations from the guidelines were applied and provide additional information on systemic cancer treatment not evaluated in previous international studies. This is the first study to quantify the use of growth factors, antiemetics and the switch from parenteral to oral drugs. Data from England on the initiation of systemic treatment were limited to recently approved cancer drugs, which excludes a large part of cytotoxic treatment regimens, while this report includes all systemic cancer treatments subsidized by the government. Prior to this study, there was no data on the use of hormonal cancer therapies during the COVID-19 pandemic.

Implications of all available evidence

This study provides high-quality evidence that nationally, systemic cancer treatment has changed little in Australia amid the COVID-19 pandemic. This has also been observed in New Zealand. This result is unexpected given that other aspects of cancer care were temporarily disrupted and contrasts with results in other countries. Both of these countries have a low incidence of SARS-CoV-2 infection and are well resourced. This is not the case for many other parts of the world, as pre-existing health disparities are further compounded by this virus. Ensuring continuity of care for noncommunicable diseases during the COVID-19 pandemic remains a challenge globally.

About Mark A. Tomlin

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