Lung cancer is the largest cause of cancer deaths in the world and there is no doubt that 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 programmes in many countries were suspended, diagnostic tests and procedures deferred and only the most urgent symptomatic cases were referred for diagnostic follow-up.
However, a new report reinforces the need to prioritise lung cancer screening and treatment to reduce further avoidable deaths and suggests there are six ways governments and regulators can improve patient outcomes during the pandemic. The report was developed by the World Economic Forum, who, in partnership with the Lung Ambition Alliance, launched a COVID-19 Taskforce in early 2020 amidst the outbreak of the pandemic. Leading experts in health care provision, patient representation, policy and industry from across Europe (France, Germany, Italy, Spain, the United Kingdom) met regularly to discuss the current global healthcare environment and plan for the future in improving the resilience of lung cancer services.
Learning Lessons from Across Europe – Prioritising Lung Cancer after COVID-19, highlights how, in just 12 months of the pandemic, lung cancer progress in diagnosis has been pushed back, with further impact on treatment likely the longer the pandemic continues.
In response to the fact that over 40% of countries reported a complete or partial disruption to lung cancer services due to the pandemic[i], the Lung Ambition Alliance and the World Economic Forum have launched a series of recommendations for governments and regulators on how to improve the short- and long-term resilience of lung cancer services, to ultimately improve patient outcomes.
In the short term:
- Symptom identification: The public and healthcare professionals need better information about how to spot the differences between COVID-19 and lung cancer so that people know which services to access.
- Reassurance on safety: Patients need reassuring that services are safe for them to access and so there needs to be investment in COVID-19-free clinical spaces, with appropriate communication about how services are being kept safe.
- Public awareness: There needs to be public health information campaigns about lung cancer to raise the public’s awareness of the signs and symptoms of lung cancer, and encourage them to seek help if they are concerned about their health.
In the longer term:
- Screening and diagnosis: There needs to be investment in strategies to identify lung cancer patients more proactively, such as targeted screening programmes for those people at risk
- Robust data: Real time data collection and analysis is needed at a national and local level to identify and address the impact of COVID-19 on lung cancer patients.
- Primary care capacity: There needs to be investment in capacity at a primary care level to ensure all patients with suspected lung cancer can be swiftly referred to specialist care.
Data and technology
The report indicates that, on a European level, there is a need for increased data sharing – not only on a country-by-country basis, but also within countries at a regional level. DATA-CAN, the UK’s Health Data Research Hub for Cancer, has shown how real-time data can be a vital component of the response to COVID-19 and is currently establishing a Real Time Data Network (RTDN).1
The global TERAVOLT consortium was also established in 2020 in response to the COVID-19 pandemic and is a physician-led syndicate focusing on the impact of the pandemic on patients with thoracic malignancies.2
There is also a role for new technologies such as machine learning to analyse and interpret data collected. Gemelli ART (Advanced Radiation Therapy) of the Agostino Gemelli IRCCS University Hospital Foundation in Italy has developed the GENERATOR Tracer RT protocol, a mobile application that allows the collection and analysis of patient data through an artificial intelligence system, monitoring the health status of these patients as they undergo radiation treatment.3
Data such as this would enable services to understand their current demand, identify patients who were no longer accessing services and plan capacity to address the larger than expected number of patients now in the system following the pandemic. The data will also be useful to understand the impact of the pandemic on lung cancer patients’ outcomes from the point of diagnosis throughout their treatment journey. However, considerations must be taken to align with national consent and data privacy laws.
Learning Lessons from Across Europe – Prioritising Lung Cancer after COVID-19 concludes that, while forward progress was temporarily stalled due to the COVID-19 pandemic, coming together to reflect on experiences, barriers, and lessons from delivering lung cancer care during a pandemic offered promise for short-term solutions and future advances in care delivery. It is the hope of those engaged in this work that the recommendations inform the choices of European policy-makers in addressing lung cancer care and offer a framework for those in other regions of the world to collate learnt experiences and develop recommendations that will improve access and outcomes for lung cancer patients everywhere.
Arnaud Bernaert, Head of Health and Healthcare at the World Economic Forum said: “Producing and rolling out a COVID-19 vaccine within one year required public-private cooperation on a global scale – it showed what we can do together. This report highlights policy priorities that can be put into place so cancer patients can access the care they need. The pandemic has strained our health and health systems, but there are lessons that can be applied in parallel with treating COVID-19. We hope that the public and private sectors can work together in the year ahead.”
David Baldwin, Chair, UK Clinical Expert Group for Lung Cancer and Mesothelioma and Report Taskforce member says, “We clinicians are seeing similar late presentations of lung cancer to those that were the norm 20 years ago. With disruptions at an unprecedented level, lung cancer patients simply can’t afford to have the clock wound back to where things were. We must redouble our efforts to diagnose patients early, by urgently restoring awareness and early diagnosis campaigns, rapid diagnostic and treatment pathways and approval of national lung cancer screening programmes. Patients deserve fresh investment and services to make up for lost time and accelerate innovation in lung cancer treatment options.”
[i] World Health Organisation. [online] COVID-19 and NCSs. Available at: https://www.who.int/docs/default-source/ncds/ncd-covid-19/for-web—rapid-assessment—30-june-2020-(cleared).pdf?sfvrsn=6296324c_20&download=true. Accessed January 2021
1 Lai, Alvina, “Estimated impact of the COVID-19 pandemic on cancer services and excess 1-year mortality in people with cancer and multimorbidity: near real-time data on cancer care, cancer deaths and a population-based cohort study” BMJ Open, 10(11), 2020. Available at: https://bmjopen.bmj.com/content/10/11/e043828. Accessed January 2021
2 The TERAVOLT Global Consortium, 2020. Available at: http://teravolt-consortium.org/ Accessed January 2021
3 Gemelli Generator, “Gemelli: an app dedicated to cancer patients and staff for monitoring during the pandemic” [Press release], 18 November 2020, Available at: https://gemelligenerator.it/per-te-paziente-news/gemelli-una-appdedicata-a-pazienti-oncologici-e-personale-per-il-monitoraggio-durante-la-pandemia/ Accessed January 2021