In a virtual Congressional briefing, the American Association for Cancer Research (AACR) presented highlights of its comprehensive new publication, Report on the Impact of COVID-19 on Cancer Research and Patient Care. The report, which runs more than 100 pages, delves into the pandemic's chilling effects in detail, and states that major efforts are needed to overcome its harms on U.S. cancer research and patient care.
The AACR released a call to action of specific recommendations to help rebuild the cancer research and patient care infrastructure. In addition, the new report contains the stories of a number of cancer patients, some of whom spoke during the Congressional briefing. Several put in a plea for people to get vaccinated against COVID-19, noting that unvaccinated people pose a special risk for immunocompromised cancer patients.
Antoni Ribas, MD, PhD, FAACR, who chaired the AACR steering committee that prepared the new report, said that Congress needs to allocate the new funding required to restore the battered cancer research infrastructure. Ribas, who served as AACR President in 2020-2021 and chaired the AACR COVID-19 and Cancer Task Force, is Professor of Medicine, Surgery, and Molecular & Medical Pharmacology at the University of California Los Angeles and Director of the Tumor Immunology Program at the Jonsson Comprehensive Cancer Center.
On the bright side, Ribas pointed out that the cancer research community developed tools to help researchers address COVID-19. These included developing antibodies, pioneering targeted therapies, "and the best example of all is the COVID-19 mRNA vaccines," he said.
The report stated, "The tremendous success of the COVID-19 vaccines has renewed enthusiasm for mRNA-based cancer immunotherapies, and many cancer scientists believe that the next wave of breakthrough mRNA technologies will revolutionize the landscape of cancer vaccines."
Sen. Roy Blunt (R-MO) agreed with Ribas on the promise of mRNA vaccines, which he called "a different approach." Blunt said the active collaboration of the federal government with the private sector, along with increased funding, have paid off in COVID-19 vaccines, and that increased investments in basic research at the National Institutes of Health (NIH) need to continue. "Now is the time to build on our success," he noted.
As shown in the report, mRNA was tested as a cancer vaccine in mice in 1995; in 2002, the first clinical trial was conducted using immune cells containing mRNA against prostate cancer; in 2009, the direct injection of mRNA was tested for melanoma treatment; and in 2017, the first human testing of personalized mRNA cancer vaccines was begun by Moderna.
The new report shows that, in the U.S. in 2020, the risk of COVID-19 infection was 7 times higher in patients diagnosed with cancer compared to those with no history of cancer. Among patients with cancer, the most vulnerable to infection are those with hematologic malignancies, those with lung cancer, and those receiving B-call targeted therapies.
The new AACR report addresses the pandemic's health care disparities; for example, Black patients with breast or prostate cancer were at more than a 5 times higher risk of COVID-19 infection compared to White individuals.
"This pandemic has really laid bare the inequities in cancer care," said Ana Maria Lopez, MD, MPH, MACP, FRCP, a member of the AACR report's steering committee. She noted that COVID-19 has caused the highest drop in life expectancy since World War II-a drop that was twice as high in Black people as in White non-Latinx individuals.
"Surely there will be a next pandemic; we need to prepare," said Lopez, who is Professor and Vice Chair of Medical Oncology at Sidney Kimmel Medical College; as well as Medical Director for Medical Oncology and Chief of Cancer Services at Jefferson Health New Jersey, Sidney Kimmel Cancer Center, Thomas Jefferson University.
As previously reported by Oncology Times, routine cancer screenings have taken a hit during the pandemic. There was an 87 percent decline in U.S. breast cancer screening in April 2020 compared to the same month over the previous 5 years, the new report shows. Sen. Amy Klobuchar (D-MN) said she was one of the women who delayed her screening mammogram; she said she was subsequently diagnosed with Stage IA breast cancer and has been successfully treated with a lumpectomy and radiation.
"It was a reminder that each day is a gift," said Klobuchar. She added that one in three American adults delayed or skipped health care during the pandemic, and she knows that many Americans are behind on their cancer screenings. To help get cancer screenings back on track, Klobuchar has co-introduced the Preventive Care Awareness Act with Sen. Susan Collins (R-ME). "I'm going to keep fighting until we get this done," said Klobuchar.
For the cancer research community, the pandemic was disastrous, costing NIH and its grantees $16 billion in research costs, according to the report. A recent AACR survey of cancer researchers showed that 87 percent of respondents experienced lost productivity due to the pandemic, and 61 percent reported that they missed cancer advancement opportunities because of the pandemic. There was suspension of laboratory activities and there were delays in reporting research results. There was a limited availability or lack of job opportunities for early-stage investigators because academic institutions are facing "unprecedented financial challenges because of the pandemic," in the report's words. There is a clear need for strong funding, mentorship, and support "to prevent talented scientists from exiting the cancer workforce," the report stated.
While the NIH and the National Cancer Institute (NCI) adopted flexibilities, "additional funding is needed to defray the costs incurred by the pandemic and revitalize the medical research enterprise," the report stressed.
The AACR's call to action to restore the pandemic-battered cancer research infrastructure includes the following.
Investing in Medical Research
* Offset pandemic-related research costs by providing at least $10 billion for NIH and its grantees in emergency supplemental funding, as proposed in the Research Investment to Spark the Economy (RISE) Act of 2021.
* Increase investments in cancer research and treatment by supporting predictable growth for the NIH and NCI, including at least $3.5 billion for NIH and $1.1 billion for NCI in fiscal year (FY) 2022, for a total funding level of $46.4 billion for NIH and $7.6 billion for NCI.
* Expand tax policies to encourage philanthropic giving to nonprofit cancer research organizations that fund high-risk research.
Rebuilding Public Health Infrastructure
* Develop a multiyear investment strategy to rebuild state, local, and federal public health infrastructures, including the health workforce and the Strategic National Stockpile, so the U.S. is in a better position for future pandemics.
* Empower public health officials to speak directly to the public about the science of health emergencies, and invest in a national public health data reporting system to better track public health threats and all diseases, including cancer. Lopez decried the misinformation and disinformation about the pandemic that have proliferated, some targeted to the underserved, she noted.
* Support the National Center for Chronic Disease Prevention and Health Promotion of the Centers for Disease Control and Prevention to reduce the incidence of comorbid chronic conditions. These investments should include $559 million in FY 2022 for cancer prevention and control programs, including public awareness campaigns designed to encourage and build on pre-pandemic screening levels.
Expanding Access to Health Care & Telehealth
* Enact policies that broaden health care coverage to reduce inequities, such as expanding Medicaid.
* Deliver a permanent extension of telehealth services approved by the Centers for Medicare & Medicaid Services (CMS), and support high-speed broadband to reach underserved areas and reduce the digital divide. In July 2021, the use of telehealth was 38 times higher than before the pandemic, the new report stated; fully 43 percent of users say they want to continue using telehealth after the COVID-19 pandemic. Currently, CMS flexibilities to expand telehealth services are only permitted during a medical emergency. So Congressional action would be needed to extend coverage once the pandemic emergency ends.
Strengthening & Modernizing Clinical Trial Development
* Support the FDA's regulatory science initiatives and advance the development of oncology products by providing an increase of at least $343 million in discretionary budget authority in FY 2022.
* Increase diversity in clinical trials and alleviate the financial burden on prospective trial participants by reimbursing patients for ancillary trial-related costs, such as transportation and lodging.
The new AACR report is very comprehensive, covering the following: understanding the COVID-19 pandemic; cancer researchers working to combat the pandemic; cancer in the midst of COVID-19 and beyond; the future of cancer science and medicine beyond COVID-19; and policies to combat the impact of a global health crisis on cancer science and medicine, including ways of addressing disparities exacerbated by the pandemic.
Peggy Eastman is a contributing writer.