The finding that a month's delay in cancer treatment can raise a patient's risk of death by around 10 percent-reported by a systematic review and meta-analysis published in the British Medical Journal late in 2020-was one of the devastating factors under discussion at the 2021 World Cancer Leaders' Summit, convened to assess the impact of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic on cancer care (2020; doi: https://doi.org/10.1136/bmj.m4087).
The talks were hosted virtually by the American Society for Clinical Pathology (ASCP) and organized from Geneva by the Union for International Cancer Control (UICC). Around 600 key cancer decision-makers from about a hundred countries met online to assess whether innovations stimulated during the pandemic could be harnessed globally to improve cancer treatment and prevention-and to do so more equitably than previously.
"When COVID arrived, it arrived like a hurricane," said UICC President, Anil D'Cruz, MBBS, MS, DNB, Director of Oncology of Apollo Hospitals, India. "The uncertainty of the threat that it posed had folks wondering. They were protecting themselves against COVID and battling for survival against this disease. Cancer resources were re-directed. Cancer wings were closed. So, cancer patients did not have that hospital resource," he told a press briefing after the conference.
"If you look at the U.S., there was a 46 percent decline in the number of newly diagnosed cases across six common types of cancers: breast, colorectal, esophagus, stomach, lung, and pancreatic between March and April of 2020. Frighteningly, the NCI estimates that this is going to result in 10,000 excess deaths from just colon and breast cancers over the next 10 years," said Cruz.
A Canadian report published in The Lancet, had found that half of those surveyed had their cancer care appointments cancelled, postponed, or rescheduled because of COVID-19. The researchers also found three-quarters of appointments had been lost by patients waiting for diagnosis or recently diagnosed (2020; https://doi.org/10.1016/S1470-2045(20)30397-1).
But the pandemic had underlined the ongoing need for more international co-operation and collaboration to tackle cancer. As had been found in the fight against SARS-CoV-2, the Summit attendees concluded that international solutions were needed to make (old and new) cancer treatments more available than before in all countries and all patients irrespective of their ability to pay.
The Summit speakers talked about specific ways of reducing inequity in cancer care in the future-within individual countries and around the world-by harnessing co-operative methods being set up to tackle the pandemic. But Elisabete Weiderpass, MD, MSc, PhD, Director of the International Agency for Research on Cancer (IARC), said that the pandemic had worsened the position of underserved communities. A key IARC initiative had been looking at ways of tackling this.
"We have assessed the COVID-19 [impact] on cancer screening programs in 17 low- and middle-income countries, and we observed that screening was suspended for more than 30 days in, basically, all countries," she said. Diagnosis and cancer treatment had also been suspended for more than 30 days in the majority of these countries.
But Weiderpass said progress and innovation in cancer research and prevention could be used to reduce inequity in the cancer care. She said that IARC was developing a new strategy for the global cancer task force under the slogan of Build Back Better.
"Evidence-based tools were being developed to guide health systems response during future pandemics," she said. These could mute the impact of a future pandemic on cancer management, and could also improve algorithms for cancer care at all times.
The Cancer Leaders' Summit foresaw a huge potential benefit for cancer medicine from innovations such as artificial intelligence, telemedicine, virtual centers of excellence, and molecular research such as messenger RNA (mRNA) vaccine technology-all of which had been stimulated and enabled by the imperative of fighting SARS-CoV-2.
Dan Milner, MD, MSc, ASCP Chief Medical Officer, delivered the good news. "One of the wonderful things that has come out of this pandemic is mRNA technologies that have been used for [creating] vaccines."
Although mRNA had been discovered more than 60 years previously, the techniques to amplify it (discovered 30 years later) had paved the way for mRNA to be used in diagnostics. He said that the first cancer vaccine, an mRNA vaccine for melanoma, had been produced in 2008.
"So, using mRNA as a vaccine wasn't new with COVID," he noted. "In fact, the platforms that developed the first melanoma vaccine were the same used to develop both the Pfizer and the Moderna vaccines (for SARS-CoV-2)."
Milner said this was important because cancer was not common enough to make recruitment for large, randomized studies easy. "So, the ability to massively test a technology like an mRNA vaccine [in cancer] was never going to be the case. But now, with the pandemic, we've actually done that. Billions of doses of the mRNA vaccines have been given. The safety profile, the efficacy (in an infectious disease) is there. And that will greatly inform and catapult the ability to use these vaccines for cancer as well."
Milner said innovations that harnessed processes around mRNA had been greatly enhanced by all of the learning from the pandemic-especially for diagnosis and treatment of cancer. "But most importantly: As we advance those things and move them forward, [we] have to consider our colleagues and collaborators [in low-and middle-income countries], and see how these vaccines-or any interventions-can be very quickly and rapidly deployed to those settings, because the cancer burden is much higher there," he stated.
Milner was questioned about cervical cancer prevention, which he said could be helped by increasing the cervical cancer vaccination rate, which was currently only at the 20-30 percent, internationally. COVID-19 vaccination campaigns had reached 80-90 percent of people in some nations around the world. So, there could be clues about how to achieve these levels of vaccine compliance with cervical cancer.
"Hopefully, we will learn something about motivation, about activation, about logistics that will get these vaccines out there faster, and that will directly help the cervical cancer vaccine campaign."
Speakers and delegates at the Summit concluded with a call to address inequities in cancer care. Attendees urged other health care leaders, not-for-profit organizations, and governments across the world to focus and work together on efforts to increase equity.
"Inequities and disparities in health and care have always existed, but COVID-19 brought them to the forefront of discussions about global public health," said Cary Adams, MSc, PhD, Chief Executive Office of the UICC. "We, as leaders of the cancer community, must take those experiences and use them to make cancer prevention and care more accessible and equitable."
Peter M. Goodwin is a contributing writer.