ESMO 2020 Congress Highlights Impact of COVID-19 on Cancer Care

By Adam Hochron
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At the opening press conference of  the ESMO 2020 Congress, presenters from around Europe and Asia looked at the impact of the COVID-19 pandemic that forced the in-person meeting to be shifted online, while expressing optimism for a more traditional event in Paris in 2021. 

The press conference’s focus was not just on the impact the global pandemic had on patients, but also the providers that treat them and how the virus has affected that care. Solange Peters, MD, PhD, president of ESMO, said there were “very sad moments” deciding to move to a virtual format, but that the decision was made for the safety of the members planning to attend. She also noted that, much like other global conferences that have gone virtual, the number of people attending has increased. Peters said that the virus has affected how those in oncology and medicine, in general, have approached their jobs in a relatively short period. 

“What we’ve been building for decades, we call them meaningful clinical guidelines in the past, now these days it’s the optimal care guidelines, suddenly gets broken. It gets completely re-questioned or re-questionable due to COVID,” Peters said. “What we considered being the standards of care could not be delivered anymore. This track is here to shape, together, as kind of a consensus, what as a minimal denominator, minimal requirements still should be delivered.

COVID-19 Impact on Cancer Treatment

One of the presentations included a survey of doctors from around the world looking at various topics including the capacity of the cancer centers, the magnitude of interruption the virus caused, and interventions implemented. 

According to the survey results, the treatment modality most affected by the pandemic was surgery, with 34% of procedures canceled or delayed due to the virus. Chemotherapy was canceled or delayed in 22% of patients, with 13.7% of radiotherapy procedures canceled or delayed. In the field of breast cancer alone, everolimus was impacted in 18% of patients. Guy Jerusalem, MD, from Liege University, also noted that earlier cessation of palliative care was observed in 32.1% of the centers involved. 

While surgical procedures were slowed due to the virus, the presenters noted that teleconsultation has risen. Follow-up consults were done remotely in 94.5% of the respondents, while oral therapy was done through teleconsultations by 92% of those responding to the survey. Immunotherapy and chemotherapy were also done by consultations in about half of cases. With the virus still affecting daily life around the world, the authors noted that 82% of participants estimated they would continue to use telemedicine for the foreseeable future. 

COVID-19 Impact on Cancer Centers

In a second presentation, Abdul Rahman Jazieh, MD, MPH from the King Abdul Aziz Medical City, reported data from a collaborative study on the impact of the pandemic on cancer care. The survey included 356 cancer centers in 54 countries, covering all continents except for Antarctica.

Overall, 88.2% of respondents reported facing challenges, including reducing services preemptively, overwhelmed systems, and a lack of personal protective equipment, among the leading challenges. The providers also noted that up to 80% of patients may have been exposed to harm in some locations while getting their treatment. 

More than 60% of those responding to the survey noted that their center did not fully close as a result of the pandemic, but their workload was reduced, and more than 70% noted they had access to the same baseline medications they had prior to the pandemic. More than 48% noted a COVID-19 diagnosis among inpatient oncology patients and 46% among outpatient patients. It was also noted that 44% reported at least one COVID-19 diagnosis among staff at their respective center. 

Burnout and Looking Ahead

Another concern raised during the press conference was the risk of burnout for providers during this pandemic. With all the challenges noted in the earlier discussions, Susana Banerjee, MBBS, MA, PhD, at the Royal Marsden NHS Foundation, said that in an effort to look at the wellbeing of cancer providers during the pandemic, the researchers conducted a survey looking at wellbeing/risk of distress, burnout, and overall job performance. 

The researchers sent out one survey to get baseline results between April and May of this year, and a second three months later. In the first survey, 25% said they were at risk of distress, compared to 33% in the second round. The rate of feeling burnout also increased from 38% in the first survey to 49% in the summer. One interesting finding was that 34% reported job performance improvement in the first survey. That number went up to 51% in the second. 

The survey also looked at the resources available and the usefulness of those resources. The respondents noted that the ability to have flexible hours, including working from home, was the most popular response (86%), followed by workshops on wellbeing, burnout, and coping (81%), and counseling services (79%). Seventy-three percent of those responding said handbooks and self-help resources were moderately to extremely helpful. 

Looking at next year, Peters said she anticipated the annual meeting having a track dedicated solely to COVID’s impact on cancer care. While it is too early to say what the next meeting will look like, Peters said she could imagine a scenario where at least part of the program will be in person. 

“There is a need for a minimal number of people to be onsite to create the value of meeting. Nobody wants to travel to watch the screen,” Peters said. “Let’s think hybrid. Let’s think also about starting again next year, providing the outbreak of the pandemic is more under control and probably that some of us or many of us can be vaccinated.”