Digital Health Closed the Gap in Cancer Care During COVID-19 and Can Do So After
Earlier this week, the director of the National Cancer Institute, Ned Sharpless, presented estimates of 10,000 excess deaths due to breast and colon cancer because of pandemic-related delays in diagnosing and treating these tumors. In an editorial Sharpless wrote that “postponing procedures and deferring care as a result of the pandemic was prudent at one time, but the spread, duration, and future peaks of COVID-19 remain unclear. However, ignoring life-threatening non-COVID-19 conditions such as cancer for too long may turn one public health crisis into many others. Let’s avoid that outcome.”
I believe we can.
The COVID-19 outbreak amplified, rather than created, existing gaps in cancer care; gaps that cannot be filled with additional beds, infusion centers, etc.
Fear of exposure to the virus, not lack of capacity, drove most of the delay and disconnection in care. The number of cancer patients who postponed follow-up care and treatments surged during the pandemic. Over the next few months there will be a surge of patients demanding cancer care, creating a backlog that threatens timely diagnoses and treatments for new patients.
The pandemic revealed that disconnected and incomplete cancer care itself can be deadly. Studies confirm that when people with cancer struggle with the pain, fatigue, diarrhea, anxiety and depression accompanying their treatment, quality of life suffers and they are more likely to die. The better their quality of life, the more likely they are to live.
Before the pandemic, a massive survey by Cancer Care, a patient support and advocacy organization, found that patients were already dealing with gaps in support. Up to one-third of people with cancer said “their ability to perform day-to-day activities, such as working, exercising, entertaining friends and family, caring for children, and preparing meals was dramatically compromised.” Yet less than 50 percent of people with cancer had adequate information on whether they would be able to continue working during treatment, how much home care was required, the emotional impact of having cancer and its treatment, and how much of the cost of care would be their responsibility.
These challenges existed before COVID-19: nearly 75 percent of oncologists spend 25 minutes or less with a patient and are only able to provide limited follow-up care. But by responding to disconnects in care during the pandemic, oncologists, patient groups, and patients may have saved and enhanced more lives.
For example, growing use of oral cancer treatments and telehealth has provided an important way of initiating treatment and keeping connection to patients. Oncologists were able to spend more time helping patients manage side effects, get refills, and take medications consistently. Patient organizations beefed up their digital engagement and helped to create continuity of care where none existed. People in rural communities, where only 7 percent of oncology practices are located, likely had better access to care.
Going back to site-based care would wipe out these gains and make it harder to treat cancer patients if another pandemic or societal disruption occurs. It would impose even greater financial burdens on health systems and physician practices.
More care should be provided digitally, not less. Virtual, real-time cancer care does not require substantial upfront investment or the development of legacy systems. Rather, we can encourage adoption of such technologies by making the reimbursement of digital health care delivery permanent. Medicare and other payers can expedite coverage of patient engagement tools, digital therapeutics, and other software driven care. The Food and Drug Administration can give priority to clinical trials that rely on remote care and to increasing the approval of new products using real world evidence. Tax credits can be created to encourage investment that expands access to 5G and broadband to underserved communities.
COVID-19 exposed cancer patients to a greater risk of death because it threatened to disrupt and delay care. The rapid adoption of digital health likely staved off more damage than would have occurred. We should build on that success. In doing so, we will be not only be prepared for the next pandemic, we will have improved the quality of cancer care for all and will save thousands of lives as a result of our efforts.
Robert Goldberg is Vice President for the Center for Medicine in the Public Interest and co-host of the Patients Rising Podcast