By Joanna P. MacEwan, PhD and Ross Maclean, MD
Great progress has been made to reduce cancer mortality rates in the United States over the last 3 decades. Mortality fell 29% between 1991 and 2017, resulting in an estimated 2.9 million fewer cancer deaths. In particular, between 2016 and 2017 cancer mortality rates fell by 2.2%, the sharpest single-year drop on record.
In our research using the Surveillance, Epidemiology, and End Results (SEER) data, we estimate that the introduction of new cancer drugs in the United States between 2000 and 2016 was associated with 1.3 million fewer cancer deaths. Given that many of these cancers had prognoses of less than 1 year prior to recent new drug approvals, our results suggest that new treatments play an especially important role in reducing mortality in certain cancers. [1,3] These findings are not surprising. Between 2000 and 2016, 106 new drugs were approved for 173 different tumor types. Most—more than 70%—of the approvals (124 new indications) were in 2008 or later. Other factors have also contributed to the decline in cancer mortality, including reduced smoking rates, increased screening, and earlier diagnosis.[4-7] However, the arrival of a global pandemic threatens this progress.
The COVID-19 pandemic has affected nearly every aspect of cancer care, from research and development of new cancer therapies, to diagnosis, and treatment. Research labs have closed, academic conferences were cancelled, and many non-COVID–related clinical trials were put on hold, all of which will likely delay drug development timelines. But, as the saying goes, necessity is the mother of invention. Pharma can do its part to prevent further delays in oncology drug development and approval by leveraging the lessons learned from the COVID-19 vaccine development process to revise and restart oncology clinical trials, modifying trial protocols to utilize virtual and digital approaches to cancer care delivery and monitoring. In particular, appropriate use of telehealth and digital tools to monitor clinical trial participants could facilitate trial participation and reduce COVID-19 exposure risk.[10,11] Post-pandemic, these adaptations should be continued as appropriate to reduce the burden of clinical trial participation on patients and caregivers.
Since the pandemic began cancer diagnoses have declined sharply in the United States, not because cancer is suddenly less common, but rather because cancer diagnoses are being delayed. The result is disease being detected at later stages and patients having poorer prognoses. Pharma can also work closely with providers to transform cancer care delivery, innovating ways to provide in-home care and treatment administration, as well as developing telehealth and digital tools for patients. Use of telehealth and digital tools to monitor clinical patients could facilitate treatment continuation and further reduce COVID-19 exposure risk.[10,14]
Pharma should also innovate ways to virtualize and digitize communications with providers. Providing information on the route of administration, dosing frequency, and adverse events for relevant treatment alternatives can help oncologists choose treatments that balance the need for office visits and hospitalization—and risk of COVID-19 exposure—with efficacy. Pharma can help provide patients with information on how to avoid complications, use digital treatment and virtual communication tools, and could ensure continuity of care with payment support to those who have lost insurance coverage.
The pandemic has also highlighted three other, related issues. First, that racial, ethnic, and cultural differences across society translate to varying levels of risk for acquiring COVID-19 and in variable access to healthcare services for those who have COVID-19—potentially exasperating existing health disparities among cancer patients. Pharma needs to account for these disparities in R&D, especially how the innovation can help underserved cancer patients. Second, the pandemic’s economic impact has not been felt evenly across society eg, how unemployment has impacted some strata of society more than others, highlighting how critical social determinants of health are in shaping how individuals, families, communities, and the country as a whole respond to public health challenges in general and for cancer patients specifically. Third, value demonstration has broadened its perspective — efficacy and safety are still key, but novel value elements such as ‘fear of contagion,’ ‘insurance value,’ and ‘scientific spillovers’ are among several value elements that the pandemic has drawn renewed and deserved attention to.
By our estimates, between 2000 and 2016 innovative cancer treatments prevented 1.3 million cancer deaths in the United States. COVID-19 is presenting serious challenges, deepening existing health disparities, and threatening the progress made in reducing cancer mortality. Pharma has a pivotal role to play in helping patients and providers navigate the new reality of cancer treatment during the pandemic, and beyond. By adapting cancer clinical trials, and equipping patient and providers with the information and tools to optimize their care, especially those with existing health disparities, pharma can both help fight COVID-19, transform cancer care delivery, and continue the great progress made in treating cancer.
Joanna P. MacEwan and Ross Maclean are employees of Precision Health Economics & Outcomes Research (PRECISIONheor), a consultancy providing services to the life sciences industry.
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- MacEwan JP, Dennen S, Kee R, Ali F, Shafrin J, Batt K. Changes in mortality associated with cancer drug approvals in the United States from 2000 to 2016. J Med Econ. 2020:1-12.
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- American Cancer Society. Global Cancer Facts & Figures 4th Edition. Atlanta: American Cancer Society; 2018.
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- The National Academies of Science Engineering and Medicine. Will COVID-19 Permanently Change Cancer Care? Published July 2020. https://www.nationalacademies.org/news/2020/07/will-covid-19-permanently-change-cancer-care. Accessed October 21, 2020.
- Henderson S. COVID-19 and Cancer: Can Pharma Stymie the Pandemic’s Impact on Mortality? Published June. 2020. https://pharmaphorum.com/views-analysis-oncology/covid-19-and-cancer-can-pharma-stymie-the-pandemics-impact-on-mortality/, 2020. Accessed December 11, 2020.
- Kaufman HW, Chen Z, Niles J, Fesko Y. Changes in the number of US patients with newly identified cancer before and during the coronavirus disease 2019 (COVID-19) pandemic. JAMA Netw Open. 2020;3(8):e2017267.
- Sharpless NE. COVID-19 and cancer. Science. 2020;368(6497):1290.
- Roffman J, Poddar P. Pharma can meet cancer patients’ and oncologists’ unique COVID-19 needs. Published March 2020. https://www.zs.com/insights/pharma-can-meet-cancer-patients-and-oncologists-unique-covid-19-needs. Accessed December 11, 2020.
- Shafrin J, Venkatachalam M. Creating Incentives to Narrow the Gap in Health Outcomes: Expanding Value Assessment to Incorporate Health Inequality. Published July 2020. https://renata279.blogspot.com/2020/07/creating-incentives-to-narrow-gap-in.html. Accessed December 11, 2020.
- Hennesey M. The Era of Pandemic Healthcare: The Social Determinants of a Health Crisis. Am J Manag Care. Published May 2020. https://www.ajmc.com/view/the-era-of-pandemic-healthcare-the-social-determinants-of-a-health-crisis. Accessed December 11, 2020.
- Shafrin J, Lang K, Maclean R. COVID-19 pandemic vindicates the ISPOR value flower. J Clin Pathways. 2020;6(5):53-56.