Lung cancer community severely impacted by COVID: report

A recently released report outlines the devastating effects the COVID-19 pandemic and its myriad disruptions has had on lung cancer research, diagnosis and treatments. The study was developed by the World Economic Forum (WEF), Lung Ambition Alliance (LAA), Global Lung Cancer Coalition (GLCC) and AstraZeneca.

Outsourcing-Pharma (OSP) discussed the report with globally recognized lung cancer expert Giorgio Scagliotti (GS), former president of the International Association for the Study of Lung Cancer (IASLC), part of the LAA. Here, he shares his thought on the ways the pandemic has disrupted lung cancer diagnosis, research and treatment—and how the health community might come together to deal with the challenges.

OSP: Could you please share the ‘elevator presentation’ description of the Lung Ambition Alliance—how it got started, its mission, who the key members/contributors are, etc.?​

GS: The Lung Ambition Alliance is a non-profit partnership between AstraZeneca, the International Association for the Study of Lung Cancer (IASLC), Guardant Health and the Global Lung Cancer Coalition (GLCC) aimed at eliminating lung cancer as a cause of death.

The first step towards this ambition will be to double five-year survival rates by 2025. The Lung Ambition Alliance is intended to be a collaborative, cross-community effort bridging the commercial and non-profit sectors to bend the survival curve in lung cancer faster and improve outcomes for patients globally

The founders have identified three key priorities to help them reach their goal, which includes screening and early diagnosis, the development of innovative medicines and quality care.

Together in partnership they established a taskforce to learn from the impact of COVID-19 on lung cancer services. A series of meetings brought together clinicians, patient representatives, policy makers and industry partners from five European countries (France, Germany, Italy, Spain and the UK) to identify lessons that could support the short- and long-term resilience of lung cancer services. 

OSP: Conversations the OSP team had with researchers early on in the pandemic centered around concerns that it would impact oncology diagnoses, treatment, and mortality figures. Do you think you could please comment on how those concerns have played out so far, in general and with lung cancer?​

GS: Even prior to the pandemic, lung cancer was the leading cause of cancer deaths across the world. The impact of COVID-19 in 2020 has had significant ramifications as healthcare professionals have had to switch focus to managing and controlling the virus, which has left a huge hole for patients with long-term conditions, such as cancer.

Health services have made heroic efforts to respond to the pandemic, but shifting resources in some cases has had a detrimental impact on services beyond COVID-19.

During the initial peak of the COVID-19 pandemic, when many people were asked not to leave their homes, there was a significant reduction in the number of people accessing healthcare services for non-COVID-19 related conditions. This has affected many different conditions, including cancer; the World Health Organization found that 55% of countries reported disruption to cancer treatment and diagnosis services.

This impact has been mirrored in the lung cancer patient community, for example, in the UK some services reported up to a 75% reduction in the number of people being urgently referred with suspected lung cancer in the peak of the pandemic. Similarly, the redeployment of frontline staff and resources to respiratory departments for care of COVID-19 patients may have also had a disproportionate impact on treatment for lung cancer.

OSP: How from your perspective has the pandemic impacted discovery of new lung-cancer diagnostics and treatments?​

GS: Prognosis for lung cancer is highly dependent on the stage at which it is diagnosed: a person diagnosed with stage IV lung cancer has a 15% chance of surviving one year – compared to 80% if detected at stage I. Spotting lung cancer early relies on several things – patients noticing symptoms or understanding their own risk and presenting to health services accordingly, primary care physicians recognising patients at risk of lung cancer and referring them quickly, and easy access to diagnostic services.

An IQVIA survey of 528 oncology specialists from across the five largest countries in Europe, identified lung cancer as the third-most-impacted area of oncology, due to delays to diagnosis from the pandemic. Patient transfer delays, reduction in access to diagnostic equipment and other system pressures are resulting in a decrease in achieving a diagnosis within critical time.

The COVID-19 pandemic has had a dramatic impact on the early detection of lung and other cancers. In the first few months of the pandemic, screening programs in many countries were suspended, diagnostic tests and procedures deferred and only the most urgent symptomatic cases were referred for diagnostic follow-up. The ensuing delays in diagnosis have led to a high number of avoidable cancer deaths

The COVID-19 pandemic has had an impact on clinical trials for lung cancer, with only 14% of sites in Europe continuing to enroll patients at the same level as prior to the pandemic. On the other hand, we have also seen innovations in the way trials are conducted and reviewed, such as greater use of real-world evidence, remote monitoring and rolling reviews, which should be evaluated for continued use as we enter a post-COVID-19 world.

OSP: How does COVID-19 complicate lung cancer diagnoses?​

GS: The challenges in early diagnosis and treatment of lung cancer are now exacerbated by the overlap between symptoms of COVID-19 and lung cancer, and the need for respiratory physicians in the care of patients with either condition. It is important to learn lessons from the impact of the pandemic on health systems and care delivery now, so we may work to rapidly resolve disrupted care pathways and secure improvements to lung cancer services and patients’ outcomes in the long term.

OSP: Does a COVID-19 infection leave a patient more vulnerable to developing lung cancer?​

GS: Most lung cancer are more vulnerable as they are at an increased risk due to their weak immune systems caused by their cancer or current treatment. Additionally, if they are undergoing radiotherapy this can also increase their vulnerability.

OSP: Could you please explain why it’s important to increase awareness of lung cancer and its symptoms, to medical professionals and the public?​

GS: The impact of the pandemic has been wide-reaching – and will continue to be so – and it is critical that we do not lose sight of the people who are at risk of becoming hidden victims of COVID-19. The past few years have seen considerable advances in treatment options for lung cancer, yet prognosis remains poor; w​e now have the opportunity to learn lessons to change this.

The findings from the taskforce should assist governments, health systems, healthcare professionals and others to come together to understand the effect of the pandemic on lung cancer care, to address the immediate impact on lung cancer services, and to ensure the resilience of the system in the longer term for the benefit of lung cancer patients.

OSP: Do you have anything else you’d like to add?​

GS: Lung cancer is the leading cause of cancer death worldwide. Trends in incidence and mortality vary between countries, but globally lung cancer is the most common cancer and is responsible for one in every five deaths from cancer. 

The past few years have seen considerable advances in treatment options for lung cancer, yet prognosis remains very low. In Europe, fewer than 15% of people with lung cancer survive up to 5 years.

One of the main reasons for this poor prognosis is that a large proportion of lung cancer cases are detected at an advanced stage, when treatment options are limited. Prognosis for lung cancer is highly dependent on the stage at which it is diagnosed: a person diagnosed with stage IV lung cancer has a 15% chance of surviving one year – as compared to over 80% if detected at stage I.

But there is also room for some optimism. The recent data published at the end of 2020 by the American Cancer Society  indicate a small but significant improvement in five-year survival rate indicating the initial effects of the impact of targeted therapies and immunotherapy combined with a progressive amelioration the way in which patients are staged at the time of the diagnosis.