Delaying Therapy or Risking Exposure: A Decision No One Should Have to Make

by Mike Hooven, CEO at Enable Injections – LinkedIn published

Over the past 30 years, innovation driven by clinical researchers and the pharmaceutical industry has resulted in new therapies and brighter futures for patients. Today, the global healthcare community’s ability to move swiftly and address unmet needs has never been more evident than the unified efforts we’re seeing around SARS-CoV-2 (COVID-19).

While we have mobilized to meet immediate pandemic needs, we must also continue looking ahead. It’s important to consider how we can apply our collective learnings from this unique moment to drive advances and ignite meaningful changes for patients facing a range of life-threatening conditions in the future.

Insights and Learnings From the Pandemic

The advent of the first global pandemic in nearly a century cast the U.S. healthcare system in a new light. Highlighting the strength and resilience of our institutions and healthcare professionals to mobilize, improvise and rally to support patients, family members and communities, the pandemic also magnified the fragility of the best healthcare system in the world.

Hospitals challenged with an influx of highly contagious patients with intensive medical needs that already faced resource constraints pre-COVID-19 suddenly found themselves bursting at the seams, short of staff and hoping to survive yet another day. While the focus has been on the patients diagnosed with COVID-19, the pandemic’s effects also extend to millions of others whose care has been impacted.

The magnitude and speed with which the virus spread forced healthcare facilities nationwide to redeploy resources, including skilled medical professionals, durable medical equipment and disposable supplies to care for COVID-19 patients. As a result, those with other life-threatening or chronic conditions were often left on the sidelines, with daunting concerns about risk and limited access to care. Consider the following:

• According to a survey conducted through the American Cancer Society’s Survivor Views research panel, the pandemic has had a significant negative impact on cancer patients and survivors currently undergoing treatment.
• In fact, 9% of cancer patients in active treatment reported cancellations or delays in potentially life-saving therapies due to either office or facility closures or concerns about contracting COVID-19.[i]

Those fortunate enough to have access to necessary treatments found themselves in a seemingly no-win scenario, deciding between delaying their treatment or risking exposure to the virus. Researchers from the University of Minnesota reported:

• An estimated 71.9% of patients actively undergoing cancer treatment expressed they were moderately or extremely concerned about contracting COVID-19.
• More than 90% were afraid of “a severe manifestation of the infection.”
• Up to 17.9% of patients reported changing their treatment plans as a result of the pandemic, with risk of exposure being the most commonly cited cause for change (80.8%).[ii]

The pandemic’s impact on oncology treatment is further illustrated with data from recent Avalere analyses of billings for the top-10 brand oncology products (ranked by Medicare Part B spending in 2018). Between February and May 2020, monthly billings for provider-administered oncology therapies were 22% to 50% lower than in the same period in 2019 (-22%, -26%, -39%, -50%).[iii]

We have seen dramatic shifts in how healthcare is practiced due to the pandemic, as reflected in the 300% year over year increase in telehealth visits between March 15 and April 14, 2019, versus 2020.[iv] While the percentage of telehealth visits relative to total healthcare visits has declined since its peak, it remains significantly higher than pre-pandemic rates.[v] While all changes like this won’t necessarily be permanent, it appears that many could be here to stay.

A Vision for the Future

The long-term impact of limited access to cancer services as a result of COVID-19 will not become apparent for some time. However, a 5–10% decrease in cancer survival in high-income countries has been predicted – potentially hundreds of thousands of lives will be lost.[vi] As recently reported in JAMA Oncology, an app has been developed to help oncologists assess the risk/benefit of proceeding with cancer treatment in the COVID-19 environment. While I commend the authors for their work, I would argue the solution is not in better informed decision making – it is in eliminating the need to make such decisions entirely.[vii]

Notably, change has not been swift for those requiring infusion therapy. In the absence of change, the post-pandemic environment for these patients seems to carry the same burdens as before; long hours in a hospital or infusion center receiving treatment in addition to heightened concerns of exposure to the next formidable virus. Currently available therapies will always fall short of their full potential without flexible approaches to delivery and administration that eliminate the need to defer or delay treatment because of access to facilities or concerns about exposure.

It is incumbent upon industry, with the resources and reach to affect real change, to act upon what we’ve learned from the pandemic and pursue approaches that provide patients and healthcare providers with solutions that allow, to the greatest extent possible, flexible administration of life-saving therapeutics either with, or potentially without the assistance of a healthcare provider.

No one wants to face a life-or-death decision about delaying their therapy – and no one should ever have to.

References

[i] American Cancer Society Cancer Action Network (2020). Understanding Access to Care During the COVID-19 Pandemic.

[ii] Lou E., Teoh D., Brown K., Blaes A., Holtan S. G., Jewett P., et al. (2020). Perspectives of Cancer Patients and their Health During the COVID-19 Pandemic. PLOS ONE.

[iii] Young J., Peng J. & Sullivan, M., (2020). Access to Medicare Part B Drugs Remains Challenging During COVID-19. Avalere.

[iv] EHRN (2020). Expansion of Telehealth During COVID-19 Pandemic.

[v] EHRN (2020). Telehealth: Fad or the Future.

[vi] The Lancet Oncology (2020). Safeguarding Cancer Care in a Post-COVID-19 World. The Lancet. Oncology, 21(5), 603.

[vii] The Lancet Oncology (2020). Safeguarding Cancer Care in a Post-COVID-19 World. The Lancet. Oncology, 21(5), 603.