As lockdown policies and social distancing guidelines force people around the world to stay inside and minimise contact, the toll this situation will have on cancer patients will not be known for quite some time. However, based on recommendations from health officials and professional organizations, we know that routine screening, follow-up and monitoring activity have diminished significantly over the course of the last two months.
Diaceutics has started tracking the diagnosis and biomarker testing rates for specific cancer types. The initial analysis of the US market indicates that newly diagnosed metastatic non-small cell lung cancer patient volumes have declined just over 30% from February of 2020 to March 2020. This stark drop in just one month has also impacted the rates of KRAS, BRAF and EGFR testing, which are key biomarkers supporting the appropriate selection of precision medicine therapies that benefit certain patients. Specifically, nearly 4,000 fewer EGFR tests were performed in the month when most of the country initiated strict “stay-at-home” orders, representing a 13% drop from the previous month.
Declines were also seen in colorectal cancer (14% lower), acute myeloid leukaemia (also 14% lower), breast cancer (8.4% lower) and ovarian cancer (8.6% lower). The larger decrease in lung cancer diagnoses may be due to the fact that COVID-19 is a respiratory disease and common symptoms may lead to a mistaken assumption of infection with the novel coronavirus. Another reason may be that patients with a persistent cough refrain from seeking medical intervention to avoid contracting COVID-19. The decrease in AML diagnosis is particularly concerning as these patients are often critically ill and need to initiate treatment as soon as possible, within just a few days, in order to achieve the best possible outcome.
Laboratory personnel have corroborated these figures with their own qualitative feedback, indicating that testing volumes and biomarker tests are decreasing significantly. Some labs are limiting the amount of staff they have working at any one time, even adjusting their shift schedules to ensure groups do not inadvertently spread the infection.
One of the biggest questions is how the landscape will recover as the infection curve declines and individuals start to resume a semblance of “normal” activities. It may actually take a more prolonged period of time to get back to pre-COVID-19 levels of testing if some patients prefer to wait until cases drop to near zero or even until a vaccine is available.
The implications of decreased testing are of great concern for many stakeholders including physicians, hospitals, laboratories, pharmaceutical companies and, most importantly, patients. Diagnosis and biomarker testing is the earliest indicators of treatment, which can include new targeted therapies with the potential to improve patient outcomes; they should not be delayed. Routine screening for breast, ovarian and colorectal cancer also need to resume quickly as they constitute effective preventive and early detection measures.
The pandemic has significantly and negatively altered the way cancer patients are being diagnosed and treated in the near term. Diaceutics will continue monitoring the landscape as more data becomes available over the months to come.