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.
This year’s Cancer Progress Report from the American Association for Cancer Research provides a chilling overview of the impact COVID-19 has had on cancer.
The COVID-19 and Cancer Special Feature in the AACR report includes the following data:
Electronic medical records from 190 hospitals spanning 23 states show that the number of screening tests for early detection of cervical, breast, and colon cancer conducted in the United States plummeted by 85% or more after the first COVID-19 case was reported in the United States.
79% of those who are actively undergoing treatment had to delay some aspect of their care as a result of COVID-19.
Delays in cancer screenings and treatment are projected to lead to more than 10,000 additional deaths from breast and colorectal cancer over the next decade.
There was a 74% decrease in the number of new patients enrolling in clinical trials during the first two weeks of May 2020 compared with the same period in 2019. Since then, enrollment in clinical trials has increased somewhat, but it still remains 30% lower than before the COVID-19 pandemic.
These setbacks are occurring against the backdrop of receding cancer death rates and at a time when FDA is approving cancer therapies at an unprecedented pace.
“One striking measure is the number of cancer drugs that have been approved in the period that was covered by the progress report,” AACR President Antoni Ribas said to The Cancer Letter. “This did not happen by chance. It’s because of the increase in knowledge leads to so many cancers being treated with the right drugs.”
Thirty-five treatments were approved by FDA. This is the highest number ever reported in any prior Cancer Progress Report during the past 10 years. The AACR Cancer Progress Report 2020 outlines advances made against cancer from Aug. 1, 2019, to July 31, 2020.
Treatments approved by FDA include:
One molecularly targeted therapeutic and one immunotherapeutic approved for treating cancers with a specific genetic biomarker regardless of the type of cancer;
The first PARP-targeted therapeutics for use in the treatment of prostate cancer and pancreatic cancer;
The first molecularly targeted therapeutic approved for treating a rare type of cancer called epithelioid sarcoma; and
The first antibody-drug conjugate for use in the treatment of an aggressive type of breast cancer called triple-negative breast cancer.
According to the latest data, the U.S. cancer death rate declined by 29% from 1991 to 2017, a reduction that has saved 2.9 million lives. The cigarette smoking rate among U.S. adults has fallen to less than 14%, down from 42% in 1965, largely due to public education and important policy initiatives.”
COVID-19 and cancer
The report’s section on COVID-19 and Cancer offers a glimpse of what’s ahead for oncology.
“The COVID-19 pandemic hit the cancer research and treatment field really hard. With the shutdown, there was a sharp decrease in many cancer procedures,” said Ribas, professor of medicine, surgery, and molecular and medical pharmacology at the University of California Los Angeles, director of the Tumor Immunology Program at the Jonsson Comprehensive Cancer Center, and chair of the Melanoma Committee at SWOG.
“The screening went down 85%. Eighty percent of the patients had some disruption in their care for cancer—delays, postponements of treatments—a remarkable impact on the care,” Ribas said.
Though care was disrupted, “an obvious choice was to postpone procedures like colonoscopies and mammograms during the early part of this pandemic. But if we do this routinely, then we’re going to be not diagnosing a lot of cancers that could be treatable,” Ribas said.
“Now is the time to advocate for going back to diagnosing cancer early and treating cancer early. One of the impacts of not doing this is the backlog that’s going to be in procedures for prevention and treatment. If we all wait until the COVID-19 pandemic is, by whatever measure under control, then there will be no way to schedule all of these backlog procedures,” Ribas said.
The report showed that changes made to accommodate and protect patients on clinical trials during the pandemic, such as the increased use of telemedicine to deliver care and assess side effects, may have a long-term positive impact on cancer research by improving access to these trials for a larger, more diverse group of patients.
“These are things that could have happened in the future—it would have probably taken years. But it was just in a matter weeks—being forced by the COVID-19 pandemic—that all of these advances happened,” Ribas said.
Disparities remain
AACR’s inaugural Cancer Disparities Progress report released Sept. 16 described the outsized toll that cancer exacts on racial and ethnic minorities and other underserved populations (The Cancer Letter, Sept. 18, 2020).
“We have to address major issues that do not allow everyone to benefit the same way from the progress that we’re documenting in this document, and we have to work toward taking away those barriers and making sure the benefit reaches everyone equally,” Ribas said.
The progress report states that disparities in cancer continue to enforce a toll on racial and ethnic minorities. Studies show that non-Hispanic Black children and adolescents who have cancer are more than 50% more likely to die from the cancer than non-Hispanic white children and adolescents who have cancer.
Other findings include:
The number of new cancer cases is projected to increase dramatically in the coming decades. The U.S. is projected to go from just over 1.8 million cases in 2020 to more than 2.3 million by 2040. This sharp increase is anticipated largely because of overall population growth and because the segment of the U.S. population that accounts for most cancer diagnoses—those age 65 and older—is expanding.
In 2020, it is estimated that 413,000 children ages <1 to 14 will develop cancer and that 328,000 children will die from the disease. If access to health care is not markedly improved, particularly in low and lower middle-income countries, it is anticipated that a total of 13.7 million cases of childhood cancer and 11.1 million deaths from childhood cancer will occur from 2020 to 2050.
According to the report, the increasing burden of cancer underscores the need for continued transformative cancer research to develop new approaches to prevention, early detection, and treatment.
The report urges elected leaders to:
Continue to support robust, sustained, and predictable growth in the NIH and NCI budget by providing an increase of at least $3 billion and $522 million respectively in fiscal year (FY) 2021, for a total of $44.7 billion for the NIH and $6.9 billion for the NCI.
Ensure that the funding designated through the 21st Century Cures Act for targeted initiatives, including the National Cancer Moonshot, is fully appropriated in FY 2021 and is supplemental to the increase in the NIH base budget.
Support FDA’s critical regulatory science initiatives by providing an increase of at least $120 million in discretionary budget authority in FY 2021.
Support the Centers for Disease Control and Prevention Cancer Prevention and Control Programs with total funding of at least $559 million. This includes funding for comprehensive cancer control, cancer registries, and screening and awareness programs for specific cancers.
