This story is part of The Cancer Letter’s ongoing coverage of COVID-19’s impact on oncology. A full list of our coverage is available here.
At The Cancer Letter, we watched with growing alarm as early warnings of the virulence of SARS-CoV-2 started pouring in from Wuhan, and later, from Lombardy.
We quickly decided to chart a course for intensive coverage of the pandemic as it reached our shores—oncologists are well-poised to take the lead in shaping research on COVID-19, and exposure mitigation strategies for high-risk patients. This coverage is collected here.
Everyone we talked to—in the U.S. and abroad—rallied, uniting oncology against a common threat. The Cancer Letter became a convener, as we opened the weekly issues to opinion leaders amid this most devastating public health crisis in living memory.
As leaders in academic and community oncology implemented tier upon tier of contingency measures, we received an unprecedented number of commentaries and guest editorials. We also published numerous conversations that reflected how cancer center directors, federal officials, private practitioners, and health IT experts were coping and responding to the pandemic in real-time.
Combined with our coverage, the result is a panoramic view of the evolution of a pandemic—meeting cancellations, emerging mortality data, the role of geopolitical forces in shaping exposure reduction strategies, dropping patient volumes, looming financial threat, and worsening racial disparities.
As we focus on the reopening of clinics and labs, and on the resurgence of the virus, here is a compendium of commentaries that look toward the future. What can we learn from COVID-19? How can leaders in oncology work to eliminate health disparities, fix telehealth, and become frontrunners in the race to develop vaccines and treatments?
The Cancer Letter is on the story.
March 13
COVID-19 and the cancer patient: A call to action for balancing cancer care and viral risk
By Karen E. Knudsen and Roy Jensen
As COVID-19 has now officially been declared a source of the pandemic, with increasing incidence across the nation, it is without question that the needs of patients with particular vulnerabilities should garner particular attention.
Given the specialized needs of cancer patients, it is imperative to consider how we, as the major cancer centers, may address and communicate how the impact of COVID-19 could impact the timing and delivery of cancer care, and to communicate this information to cancer patients.
March 20
The COVID-19 pandemic gives us the urgency—and one more chance—to address health disparities
By Robert Winn
As the crisis triggered by the COVID-19 pandemic deepens, the two separate, unequal societies that make up the United States of America are equally frightened, bewildered, and unsure of what comes next.
What community cancer centers need to know about COVID-19
By Jeff Patton & Lee Schwartzberg
Community cancer centers play an important role in this conversation and in the fabric of caring for those with cancer across the United States. As two oncologists in the community setting and as leaders of a national oncology practice partnership, we’ve spent the last few weeks with our practices and leaders in our communities, to set in place strategies to flatten the curve of the virus’ exponential spread, care for our vulnerable patients, and mitigate exposure to those providing lifesaving care.
March 27
Hollander: Fix telehealth infrastructure—or America will be just as unprepared for the next pandemic
Conversation with Judd Hollander
As U.S. health systems switch to telehealth to connect with patients—via phone calls and online video conferencing—during the COVID-19 pandemic, providers are quickly learning that the lack of a national infrastructure for telehealth is making it difficult to reach patients.
Knudsen, Flomenberg: Eliminate digital health disparities; we don’t want telemedicine to be for the one-percenters
Conversation with Karen Knudsen and Neal Flomenberg
The Sidney Kimmel Cancer Center at Thomas Jefferson University has been developing a scalable telehealth program long before the spread of SARS-CoV-2 in the United States.
April 3
Friending viral foes: The Zika story and (perhaps) lessons for COVID-19
By Scott M. Lippman
While viral epidemics pose severe challenges to society, there are instances where thoughtful efforts can turn these foes into potential friends in the fight against cancer. This is also a case study in thinking deeply, following scientific leads, breaking silos—and just sheer luck.
I believe that in the midst of COVID-19, and based on this conceptual background, it may be informative to consider the 2015-2016 viral outbreak—the case of Zika virus.
What cancer immunologists are doing about COVID-19
By Rachel Humphrey
To read the pulse from the front lines, I connected with a ready-made community of world-class physicians and scientists who assembled in 2007 because of their mutual love of immunology and also because of their mutual love, of all things, music.
The group, a blues-rock band called The Checkpoints, is composed of global leaders who are leveraging their deep knowledge of the immune system to assist in the battle against COVID-19. They include multiple heads of cancer or immunotherapy departments in major American institutions, former and current presidents of the Society for Immunotherapy of Cancer (SITC), and a Nobel Prize-winning scientist.
COVID-19 and cancer: Ethical dilemmas in immune checkpoint blockade
By Allison Betof Warner
As oncologists, we are all too familiar with making treatment recommendations and advising on end-of-life care in the absence of robust data. In ethical conundrums, we rely on guidance from our colleagues in the field, institutions, and national/international leadership bodies.
The COVID-19 pandemic has magnified many of these ethical dilemmas and raised new and unexpected challenges. I will focus here on what I consider some of the key challenges during the COVID pandemic surrounding the use of immune checkpoint inhibitors, the fastest growing option for systemic therapy for a variety of malignancies.
April 10
NCTN group chairs: Cancer trials take backseat to clinical care amid COVID-19 pandemic
By NCTN group chairs
While the National Clinical Trials Network (NCTN) groups remain open for business during the pandemic, it’s not business as usual. For good reason, clinical trials are taking a backseat to clinical care. Leadership and members themselves face significant challenges treating oncology patients, as attention and resources are diverted to minister to those with COVID-19.
Chernobyl doctor’s view of COVID-19: Trump threatens 267 years of progress in biomedical research
By Robert Peter Gale
Governments respond differently to crises which threaten the health of their citizens. For example, during the current SARS-CoV-2 pandemic, some countries instituted an immediate lockdown whilst others have not restricted social activities, or have done so too late to be maximally effective.
The question is: What prompts these different policies?
April 17
Amid COVID-19 pandemic, cancer community responds to fill data gap
By Richard L. Schilsky
As clinicians in a medical specialty that relies on evidence to guide treatment plans for individuals with cancer, we face an unfortunate dearth of data to help steer us during the coronavirus pandemic.
For our part, the American Society of Clinical Oncology has launched the ASCO Survey on COVID-19 in Oncology Registry to help the entire cancer community learn about how the pandemic is impacting the delivery of cancer care as well as the treatment and outcomes of our patients.
Lichtenfeld: COVID-19 exposed weaknesses in the U.S. health care system
Conversation with J. Leonard Lichtenfeld
“The virus will expose the weaknesses of our system at many, many levels. And research is one. And health care is another. And outcomes are going to be another still,” said J. Leonard Lichtenfeld, deputy chief medical officer of the American Cancer Society.
April 24
Berry: “Designing clinical trials doesn’t have high priority when there’s no pandemic. And then, when there’s a pandemic, there’s panic”
Conversation with Donald A. Berry
After a series of global epidemics, Don Berry has spent the past several years preparing for a serious pandemic that would be caused by yet another viral pathogen.
“People have long said that we’re not prepared for the next pandemic. We get a pandemic and then it goes away,” Berry, a professor in the Department of Biostatistics and founding chair of that department at MD Anderson Cancer Center, said to The Cancer Letter. “And so everybody says, ‘Well, okay, the next pandemic is way in the future, and so let’s not worry about it.’”
When disparities widen: COVID-19 in minority patients with cancer
By Coral Olazagasti and Narjust Duma
Recently, troubling trends and data from across the country started to suggest that minority populations, especially Hispanic and black, are experiencing higher risk for COVID-19 infections and mortality that outpace the different state’s population.
May 1
COVID-19 vs. community oncology: Flatiron’s data provides first damage assessment
Conversation with Bobby Green
Community oncology practices in the United States are reeling from a sharp decrease in business—whether you look at new patients, chemotherapy visits, or non-chemo visits—the result of reduced activity and stay-at-home orders across the country to mitigate the spread of SARS-CoV-2.
Skip Burris: These few months are going to shape health care in the coming years
Conversation with Howard A. “Skip” Burris III
The COVID-19 pandemic will change the structure and economics of clinical care and clinical trials in cancer, said Howard “Skip” Burris, president of clinical operations and chief medical officer of Sarah Cannon, the Cancer Institute of HCA Healthcare.
“The pandemic is going to create an opportunity to look at how oncology should be reimbursed and how a practice is not disadvantaged when they’re able to function electronically in some areas,” said Burris, who is this year’s president of the American Society of Clinical Oncology. “And then I think bigger picture, this pandemic will help us set some health care priorities for the population.”
May 8
COVID-19 and community cancer care: A panorama of a catastrophe
By Debra Patt and Michael Kolodziej
Much has been written about the impact on hospitals and on the health care professionals enduring horrific stress to support the acutely ill. These providers are heroes, and we are all indebted to them. But less attention has been paid to the indirect effects of the pandemic on health care, particularly the care delivered to those with chronic medical illnesses.
What does cancer care look like now? And how will it be changed forever?
Embracing the increasing value of eHealth in patient-centered cancer care during the COVID-19 pandemic and beyond
By Frank J. Penedo and Joshua Kronenfeld
With the widespread use of computers, tablets and smartphones, delivery of cancer care via eHealth platforms continues to expand. This trend has accelerated dramatically this spring, as the COVID-19 pandemic has changed the landscape of clinical care in the U.S. and around the world.
With the COVID-19 pandemic, the cancer clinical trials—they are a-changing
By Gregory Masters, Nicholas Petrelli and Kandie Dempsey
Prior to the COVID-19 pandemic, NCI estimated that about 3% to 5% of adult cancer patients participated in clinical trials.
But what can we do now with new barriers to enrollment imposed by the COVID-19 pandemic?
May 15
SARS-CoV-2 and oncology drugs. What do we mean when we talk about value?
By Garth Strohbehn, Daniel Goldstein and Mark Ratain
It is a humbling moment to reflect on not only the current situation, but also on whether drug reimbursement policy changes might help to encourage nimbler global responses to public health threats in the future.
May 22
Let’s not form blue ribbon panels to study disparities in COVID-19 deaths. Instead, let’s find the will to act
By Robert Winn and Katherine Tossas
On a chaotic COVID weekend two months ago, a friend’s child (a young, talented black and Latino student athlete) came home from college not feeling well. The young man’s mother, an executive administrative assistant, called off work to stay home with him because of his, as she described, “full-blown flu-like symptoms.”
Concerned for her son, she called her doctor to ask if she could bring him to the ER and get him COVID-19 tested, but was discouraged from doing so. When he began experiencing respiratory distress, his mother rushed him to the ER, where they ruled out strep, and flu, but not COVID-19; he apparently at the time did not meet the “requirements” set by the CDC algorithm.
May 29
CCC19 data point to extensive use of hydroxychloroquine, azithromycin, or both, by patients with cancer and COVID-19
By Otis Brawley
Nicole Kuderer and colleagues are to be congratulated for their report—in The Lancet and at the ASCO 2020 Annual Meeting—on the impact of COVID-19 on a cohort of patients with cancer.
In a very short time, these researchers used social media and novel ways of communicating to bring together healthcare providers from over 100 institutions in the US, Canada, and Europe to form the COVID-19 and Cancer Consortium (CCC19) database.
June 12
Working to end cancer in the time of COVID-19
By Peter Pisters
MD Anderson has one of the largest and densest concentrations of immunocompromised patients in the world. We consider it our responsibility to protect the health and safety of all of our patients at all times, including during a global pandemic. As we started seeing data coming from impacted countries that showed that cancer patients who contracted the SARS-CoV-2 virus are at increased risk for hospitalization and death from the infection, we knew the months ahead would require swift, significant action to ensure we could fulfill our commitment to patients.
Impact of COVID-19 on Georgia’s community providers: a snapshot from Georgia NCORP
By Guilherme Cantuaria
We surveyed our GA NCORP partners and affiliates to ascertain the impact of the COVID-19 pandemic and the shelter in place orders on daily practice and trial participation. Areas addressed in the survey included the use of telemedicine, surgery, ambulatory cancer care and testing, personal protective equipment, the impact on clinical research, and staffing.
June 19
Conquest of COVID-19: Publish it to death?
By Robert Peter Gale
Early in the War Against Cancer, when huge amounts of federal funds were suddenly funneled into cancer research, many scientists and clinicians working in other fields suddenly found it convenient—if not essential—to incorporate cancer into the title of their grant applications.
The hope was the application would be directed to a National Cancer Institute review panel, instead of a less-funded institute. The situation became so acute, some cynics commented more people were living from than dying from cancer. Fortunately, some of these re-directed research efforts were productive in unpredictable ways and helped us make substantial progress against cancer, even if total victory is not yet ours.
June 26
To expedite progress against COVID-19, a public-private “accelerator” taps into real-world data
By Jeff Allen and Susan Winckler
Real-world data is everywhere. During the COVID-19 global pandemic, we are literally generating, and collecting, real-world data every single day—from electronic health records, insurance claims, patient registries, and a myriad of other sources. But the question remains: how do we use this data to better understand, prevent, and treat this disease?
July 2
(Social + geographic) distance = Ongoing challenges in disparities for rural cancer patients
By Jennifer Dill, Marsha Kutter and Peggy Wisher
Approximately two-thirds of the NCI Community Oncology Research Programs, serve states in which the rural population exceeds 30%.
Besides the existential challenges of battling cancer, rural cancer patients have the additional issues associated with obtaining increasingly complex cancer diagnostic tests and treatment.
Heartland Cancer Research, our NCORP, is among those programs striving to provide rural patients access to outstanding care through the vehicle of NCTN treatment, cancer control, and cancer care delivery trials.
July 17
Giuseppe Curigliano: The COVID-19 curve in the U.S. will never decrease, like in Italy
Conversation with Giuseppe Curigliano
In early March, when Giuseppe Curigliano, an oncologist in Milan, first spoke with The Cancer Letter about COVID-19, the situation in Italy was “like being in a war zone” (The Cancer Letter, March 11, 2020).
At the time, it seemed unfathomable that the U.S. could face a catastrophic event of a similar magnitude.
Today, the tables have turned.
July 24
Insurers’ moves to limit telehealth amid COVID-19 are inhumane and must be stopped
Letter to the editor by Christina Cone, William T. Dod, and Henry S. Friedman
It is obvious to virtually everyone in the United States that the numbers of patients affected with COVID-19 are continuing to escalate. The impact of this is obvious, with many patients dying or permanently damaged from this dangerous virus.
However, an additional problem is the impact on patients with other medical illnesses including, of course, cancer. The Cancer Letter has reported on this several times and all of the national cancer organizations are making the same observations in trying desperately to continue to provide care hindered by the constraints imposed by the current pandemic.
