Experts call for patients to access cancer services without delay in bid to minimise COVID-19 impact on treatment outcomes in Asia

Experts call for patients to access cancer services without delay in bid to minimise COVID-19 impact on treatment outcomes in Asia

• COVID-19 has had a significant impact on cancer services negatively across Asia and there has been a drop in the number of patients accessing cancer services in the region
• New Normal, Same Cancer campaign calls for patients access cancer services without delay in order to give any required treatment the best chance of success 
• To help protect people attending cancer clinics, many healthcare facilities have already adapted their practices and put in novel solutions to minimise the risk of COVID-19 transmission. Patient journeys have also been modified.  

Delhi, 10th Dec 2020 – A coalition of leading Asian oncologists in partnership with  AstraZeneca, are calling for patients to access cancer services without delay, as part of the New Normal, Same Cancer campaign. Although the long-term impact on patients is not fully known yet, recent research suggests that a one month delay in treatment can result in 6% increase in risk of death, underscoring the urgent need for patients to get the care that they require as soon as possible.  The campaign encourages people diagnosed with cancer to resume treatment that may have been paused, and those people with possible cancer signs and symptoms or who have missed routine checks, to consult a doctor.

The coalition of experts from India, Indonesia, Malaysia, Philippines and Singapore made the following statement: 

“Timely diagnosis and treatment are critical factors to determine the success of cancer treatment. The COVID-19 pandemic has posed unprecedented challenges to healthcare systems across Asia, including cancer services. As countries enter a ‘new normal’, we strongly urge cancer patients to access the right services without delay to give any treatment the best chances of success. For more information on the members of the coalition, refer to Annex A.

The COVID-19 pandemic has caused disruptions to many services for people living with cancer in Asia over the last year, as well as cancer screening in some countries. Even where services were maintained, some patients are delaying appointments, treatment and follow up appointments for fear of contracting the virus. In the Philippines, for examples, a survey found that fear and anxiety of cancer patients brought about by worries of acquiring the virus affected the health-seeking behaviour of those still about to be diagnosed.  

There was a 9% drop in first visit consultations and 30% drop in follow up consultations at the National University Cancer Institute, Singapore (NCIS) between February and March 2020, although these numbers have recovered. And in a survey of 480 oncosurgeons across India, it is estimated that 192,000 patients are likely to have delays in the timely diagnosis of cancer. Free annual Pap smear screening appointments fell by 75%.  For country-specific details, refer to Annex B.

“People are understandably more cautious about visiting hospitals and clinics at this time but avoidable delays in diagnosis or treatment can result in the cancer being harder to treat and worse outcomes for patients,” commented Fong Pei-Chieh, Medical Director of AstraZeneca, Asia Area. “Many health systems across Asia are implementing innovative models of care aimed at protecting patients from COVID-19 while still maintaining effective services for patients. “As the entire world embraces a ‘new normal’, the New Normal, Same Cancer campaign strongly urges cancer patients to access the right services with due precautions and without delay to give any treatment the best chances of success”, added Dr Mangesh Sheshrao Kamle, Therapy Area Lead Oncology, AstraZeneca India 

To help protect people attending cancer clinics, many healthcare facilities have already adapted their practices and put in novel solutions to minimise the risk of COVID-19 transmission. For many countries, telehealth has become an important part of patient services, allowing healthcare professionals such as oncologists to check in with their patients and carry out remote screening without the need for the patient to leave their home. 

Patient journeys have also been modified. For example, Tata Memorial Centre in India is avoiding complex surgeries that require multiple blood transfusions and prolonged stays in the intensive care unit. The National Cancer Centre Singapore (NCCS) has adapted treatment plans for some patients and is arranging same day diagnostic imaging and biopsy to those new referrals who are assessed to have a high likelihood of cancer, to reduce the number of clinic appointments for patients. “By coming together with experts in cancer from healthcare, policy and patient groups to share this message, we hope to encourage patients to prioritise their cancer treatment and follow up appointments, and ultimately improve outcomes for cancer patients throughout Asia.”, said Dr Ullas Batra, Senior Consultant and Chief Thoracic Medical Oncologist, Rajiv Gandhi Cancer Institute, New Delhi, India

“Healthcare services across Asia are reacting to the disruption of COVID-19 by bringing in a range of innovative and impactful models of care to maintain effective services. Many are taking steps to help address the risk of COVID-19 in cancer clinics and encourage people to attend in-person consults when required. Reassuring the public and cancer patients and survivors will be key to building their confidence to return and receive appropriate screening and care,” said Professor Chng Wee Joo, Director of the National University Cancer Institute, Singapore.

“Through the New Normal, Same Cancer campaign, we hope to empower patients to get the help they need and stop waiting until the perceived risk of COVID-19 has passed,” said Foong, from AstraZeneca.

“By coming together with experts in cancer from healthcare, policy and patient groups to share this message, we hope to encourage patients to prioritise their cancer treatment and follow up appointments, and ultimately improve outcomes for cancer patients throughout Asia.”

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About AstraZeneca

AstraZeneca (LSE/STO/NYSE: AZN) is a global, science-led biopharmaceutical company that focuses on the discovery, development and commercialisation of prescription medicines, primarily for the treatment of diseases in three therapy areas - Oncology, Cardiovascular, Renal and Metabolism, and Respiratory. AstraZeneca operates in over 100 countries and its innovative medicines are used by millions of patients worldwide. Please visit astrazeneca.com and follow the Company on Twitter @AstraZeneca.

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ANNEX A: New Normal, Same Cancer Coalition in Asia

Joint Statement

Timely diagnosis and treatment are critical factors to determine the success of cancer treatment. The COVID-19 pandemic has posed unprecedented challenges to healthcare systems across Asia, including cancer services. As countries enter a ‘new normal’, we strongly urge cancer patients to access the right services without delay to give any treatment the best chances of success.

• India – Dr Ullas Batra, Senior Consultant and Chief Thoracic Medical Oncologist, Rajiv Gandhi Cancer Institute, New Delhi, India
• Indonesia – Dr Muhammad Yusuf, Gynaecology Oncologist at Dharmais Cancer Hospital
• Malaysia – Dr Murallitharan Munisamy, General Manager and Medical Director of National Cancer Society Malaysia
• Philippines – Dr Antonio Ramos, Thoracic Surgeon Manager, Administrative Services Department, Lung Centre of the Philippines 
• Philippines - Dr Frederick Ting, Consultant Medical Oncologist, Riverside Bacolod Cancer Care Center
• Singapore – Prof Chng Wee Joo, Director, National University Cancer Institute, Singapore;  Professor, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore; Senior Consultant, Division of Haematology, Department of Haematology-Oncology,
  National University Cancer Institute, Singapore
• Singapore – Dr Wong Seng Weng, Medical Director & Consultant Medical Oncologist, The Cancer Centre

ANNEX B: Local Country Situations and Statistics

India

Effects on cancer services:

• A global modelling study projected that 59.7% of cancer surgeries would be postponed in the country, affecting over 50,000 patients. These delays will have an impact on access to care for patients with cancer, and potentially patient outcomes in the long run. 
• A cross sectional survey-based analysis across 148 cancer centres, found 95% of oncologists saw a decrease in practice after COVID-19.
• A survey of 480 oncosurgeons across India estimated that 192 000 patients are likely to have delays in the timely diagnosis of cancer. 
• A survey conducted in May 2020 among 100 cancer patients found: 

• Slot availability for teleconsultation was cited as an issue by 15 (41.7%) of the respondents, 
• Deferral of radiotherapy dates and long waiting hours beyond appointment time was a problem cited by 8 (22.2%) of the respondents,
• Deferral of surgery was a matter of concern for 5 (13.8%) respondents,
• Deferral of tumour boards was cited as an issue by 7 (19.5%) of the respondents,
• Unavailability of peer group support services and psychological counselling sessions was problematic for 34 (94.4%) of the respondents,
• Availability of chemotherapy medications was cited as an issue by 8 (22.2%) respondents,
• Availability of chemotherapy slots in day care was problematic for 20 (55.6%) of the respondents.             

Patient delays:

• A survey of patients in India found that more than 9 out of 10 patients were anxious about getting COVID-19 infection during treatment, while half were anxious because the treatment was not optimal.

Examples of solutions being implemented at a local level:

• At Tata Memorial Centre in Mumbai:

• Avoidance of complex surgeries likely to require multiple blood transfusions and prolonged intensive care unit stays,
• Adapting treatment plans whenever possible (e.g., for breast, prostate, and lung cancers); provision of palliative radiotherapy in a single fraction or weekly regimens,
• Use of teleconsults as a substitute for routine follow-up visits,
• Establishment of “screening camps” outside the hospital to reduce patient visits,
• Stringent restriction of relatives and friends in outpatient clinics and inpatient wards,
• Establishment of standard operating procedures for cases of suspected or confirmed Covid-19 infection; use of simulation drills.

Malaysia
Effects on cancer services:

• Streamline resources for the COVID-19 pandemic – non-urgent treatments, elective surgeries, hospital admissions and follow-up appointments were either delayed or cancelled
• Shorter clinic hours, prioritised radiotherapy and chemotherapy 
• Postponed imaging procedures to monitor tumour growth
• Delays and disruptions in cancer diagnosis, active treatment and routine follow-up
• Private sector – patient turnout dropped
• Medical tourism took a hit
• Financial impact on patients

Solutions Implemented:

• Digitalisation – dissemination of science around COVID-19 and cancer management
• Conducted “Knowing Lung Cancer” public awareness campaign and radio campaign
• Created awareness in relevant referral networks “Conquering Lung Cancer Together” and “Transforming Ovarian Cancer” module
• Access to affordable diagnostics and diagnostic workflows without interruption
• Establishment of referral network using artificial intelligence technology

Indonesia

Effects on cancer services:

• Free annual Pap smear screening appointments fell by 75%
• Home palliative care services were delayed indefinitely
• Cancer clinic hours were reduced from five times to two times weekly
• Mass screening services were cancelled indefinitely
• Waiting times for cancer surgeries were lengthened due to strict scheduling to prevent infection

Impact on cancer services at Dharmais Cancer Hospital

• Elective diagnostic procedures fell by 35%, radiotherapy by 13% and one-day care by 9%
• Closure of cancer screening services resulted in a 60% drop in attendance compared to 2019

Examples of solutions being implemented at a local level:

• Strict infection control measures deployed throughout the hospital
• Thermal scanning and questionnaire screening before entry into the hospital
• All patients screened for COVID-19 before treatment
• Patients with pneumonia and COVID-19 were isolated in separate areas
• Appointments were made through an app 
• Patients seen through teleconsultations and medication was delivered to their homes
• Treatment protocols and patient journeys were adjusted to ensure prompt treatment

Philippines

Effects on cancer services: 

• 85% of oncologists experiences a decrease in the number of cases they were seeing.
• Disruption of diagnosis due to delays, reduced face-to-face consults and elective procedures.

Patient delays:

• Fear and anxiety of cancer patients brought about by worries of acquiring the virus thus affecting the health-seeking behaviour of those still about to be diagnosed.
• Logistical challenges and limited access to public transportation because of quarantine restrictions that has affected both patients & health workers.

Singapore

Effects on cancer services:

During circuit breaker cancer services were affected in the following ways (but have returned to normal):

• Population cancer screening services throughout Singapore were ceased at the start of the circuit breaker 
• Cancer surveillance imaging appointments were rescheduled 
• Specialized procedures such as stereotactic body radiotherapy, radiosurgery and brachytherapy were limited

At NCIS from February to March:

• Admissions fell by 27%,
• 1,038 non urgent cases were deferred, 
• Number of first visit consultations fell by 9.4%,
• 30% drop in follow up consultations,
• In the inpatient setting, cancer surgeries were allowed to proceed as planned but all non-cancer surgeries were postponed by three months.

Examples of solutions being implemented at a local level:

• At NCCS:
• Patients on routine cancer surveillance with normal test results were called and screened for new symptoms. Those who self-reported to be well were updated on the normal test outcomes over the phone, and had their appointments postponed. This reduced the clinic outpatient load by 50 %
• Adoption of hypofractionated treatment such as the FASTForward trial regimen for breast radiotherapy or single fraction radiation therapy for palliative cases
• New referrals to the surgical oncology clinics during the COVID-19 pandemic were patients with signs and symptoms suggestive of malignancy
• New cases with a confirmed diagnosis of cancer that required tertiary cancer care were also allowed. New referrals assessed to have a high likelihood of cancer would undergo diagnostic imaging and biopsy on the same day where possible
• Hospital stay post-surgery was kept to a minimum, and patients could not have visitors during the stay. Where possible, patients post-discharge would be seen at the general hospital outpatient clinic instead of the cancer centre to avoid exposing other vulnerable, immunocompromised cancer patients
• A nurse liaison service was established to screen patients coming to the outpatient specialist clinic, linking up actively with community hospice teams thereby encouraging continued care at home
• The existing supportive care nurse clinics, which manages patients with high distress scores on the distress thermometer, evolved into a telehealth service, conducting clinical reviews via telephone and video conferencing
• Inpatient consult team communicated between families and patients and conducted family conferences and advanced care planning via video conferencing

• At NCIS:
• Telemedicine consults, home delivery of medications and online payment was encouraged
• Volunteer groups coordinated delivery of maintenance chemotherapy to childhood leukaemia patients residing outside of Singapore
• For patients undergoing radiation therapy, hypo-fractionated treatments were favoured

Thailand

Effects on cancer services:

• The Covid-19 pandemic in Thailand was effectively and swiftly contained, which meant a short lockdown period in the country.

Examples of solutions:

• In response to the pandemic, several cancer care processes and administrations were modified in accordance to government healthcare guidelines.
• Telemedicine services were originally introduced to give remote patients living in rural services access to healthcare, but the pandemic had led many leading hospitals to offer these services to cancer patients even living in the cities.
• Delivery of prescription medicines to patients homes.