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Botto E, Smith Z, Getz K. New Benchmarks on Protocol Amendment Experience in Oncology Clinical Trials. Ther Innov Regul Sci 2024; 58:645-654. [PMID: 38530628 DOI: 10.1007/s43441-024-00629-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/04/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND The drug development industry's focus on cancer-related treatments continues to rise, with narrow patient populations and complex procedures increasing the complexity of oncology protocols at an accelerated rate compared to non-oncology drugs. Tufts Center for the Study of Drug Development utilized data from a study investigating the impact of protocol amendments to compare how oncology clinical trials differ from non-oncology and identify opportunities to optimize performance in oncology clinical trials. METHODS Sixteen drug development industry companies contributed data from 950 protocols and 2,188 amendments to a study conducted in 2022 investigating protocol amendments. Analysis compared differences in amendment impact and causes between 249 oncology and 701 non-oncology protocols. RESULTS Compared to non-oncology, oncology protocols had a significantly higher prevalence (72.1% and 91.1%, respectively) and number (3.0 and 4.0, respectively) of protocol amendments. Oncology protocols with amendments had significantly lower participant completion rates compared to oncology protocols without amendments, while no significant differences were found among non-oncology. During the COVID-19 pandemic, the study found an increased number of substantial amendments, lower completion rates, and higher dropout rates among oncology protocols compared to before the pandemic. CONCLUSIONS Efforts to prevent avoidable protocol amendments in the industry have not been effective in oncology, where increasingly complex designs are reflected in difficult to predict cycle times, barriers to recruitment and retention and an increase in protocol amendments.
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Affiliation(s)
- Emily Botto
- Tufts University School of Medicine, 145 Harrison Ave, Boston, MA, 02111, USA.
| | - Zachary Smith
- Tufts University School of Medicine, 145 Harrison Ave, Boston, MA, 02111, USA
| | - Kenneth Getz
- Tufts University School of Medicine, 145 Harrison Ave, Boston, MA, 02111, USA
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Smith KL, Mead‐Harvey C, Mazza GL, Shinn EH, Frank ES, Melisko ME, Eaton C, Liu Y, Salamone JM, Pollastro T, Spears PA, Caston NE, Wolff AC, Rocque GB. TBCRC 057: Survey about willingness to participate in cancer clinical trials during the pandemic. Cancer Med 2024; 13:e7090. [PMID: 38466037 PMCID: PMC10926883 DOI: 10.1002/cam4.7090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 02/21/2024] [Accepted: 02/29/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Breast cancer patients experienced heightened anxiety during the pandemic. Also, modifications to clinical trial activities allowing for virtual platforms, local assessments, and greater flexibility were introduced to facilitate participation. We sought to evaluate the association between pandemic-related anxiety and willingness to participate in trials and how pandemic-era modifications to trial activities affect the decision to participate. METHODS We conducted an online survey from August to September, 2021 of patients with breast cancer assessing pandemic-related anxiety; clinical trials knowledge and attitudes; willingness to participate during and before the pandemic; and how each modification affects the decision to participate. Fisher's exact tests evaluated differences in proportions and two-sample t-tests evaluated differences in means. The association of pandemic-related anxiety with a decline in willingness to participate during compared to prior to the pandemic was modeled using logistic regression. RESULTS Among 385 respondents who completed the survey, 81% reported moderate-severe pandemic-related anxiety. Mean willingness to participate in a trial was lower during the pandemic than prior [2.97 (SD 1.17) vs. 3.10 (SD 1.09), (p < 0.001)]. Severe anxiety was associated with higher odds of diminished willingness to participate during the pandemic compared to prior (OR 5.07). Each of the modifications, with the exception of opting out of research-only blood tests, were endorsed by >50% of respondents as strategies that would increase their likelihood of deciding to participate. CONCLUSIONS While pandemic-related anxiety was associated with diminished willingness to participate in trials, the leading reasons for reluctance to consider trial participation were unrelated to the pandemic but included worries about not getting the best treatment, side effects, and delaying care. Patients view trial modifications favorably, supporting continuation of these modifications, as endorsed by the National Cancer Institute and others.
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Affiliation(s)
- Karen Lisa Smith
- Sidney Kimmel Comprehensive Cancer Center, Women's Malignancies Disease GroupJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Present address:
AstraZenecaGaithersburgMarylandUSA
| | | | - Gina L. Mazza
- Department of Quantitative Health SciencesMayo ClinicScottsdaleArizonaUSA
| | - Eileen H. Shinn
- Department of Behavioral Science, Division of Cancer Prevention and Population SciencesThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | | | - Michelle E. Melisko
- Department of Medicine (Hematology/Oncology)University of CaliforniaSan FranciscoCaliforniaUSA
| | - Cyd Eaton
- Biostatistics, Epidemiology and Data Management CoreJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Yisi Liu
- Biostatistics, Epidemiology and Data Management CoreJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | | | | | - Patricia A. Spears
- Lineberger Comprehensive Cancer CenterUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Nicole E. Caston
- Division of Hematology and OncologyUniversity of Alabama at Birmingham (UAB)BirminghamAlabamaUSA
| | - Antonio C. Wolff
- Sidney Kimmel Comprehensive Cancer Center, Women's Malignancies Disease GroupJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Gabrielle Betty Rocque
- Division of Hematology and OncologyUniversity of Alabama at Birmingham (UAB)BirminghamAlabamaUSA
- Division of Gerontology, Geriatrics, and Palliative CareUniversity of Alabama at Birmingham (UAB)BirminghamAlabamaUSA
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Bright K, Mills A, Bradford JP, Stewart DJ. RAPID framework for improved access to precision oncology for lethal disease: Results from a modified multi-round delphi study. FRONTIERS IN HEALTH SERVICES 2023; 3:1015621. [PMID: 36926496 PMCID: PMC10012713 DOI: 10.3389/frhs.2023.1015621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 02/10/2023] [Indexed: 03/03/2023]
Abstract
Introduction Predictive oncology, germline technologies, and adaptive seamless trials are promising advances in the treatment of lethal cancers. Yet, access to these therapies is stymied by costly research, regulatory barriers, and structural inequalities worsened by the COVID-19 pandemic. Methods To address the need for a comprehensive strategy for rapid and more equitable access to breakthrough therapies for lethal cancers, we conducted a modified multi-round Delphi study with 70 experts in oncology, clinical trials, legal and regulatory processes, patient advocacy, ethics, drug development, and health policy in Canada, Europe, and the US. Semi-structured ethnographic interviews (n = 33) were used to identify issues and solutions that participants subsequently evaluated in a survey (n = 47). Survey and interview data were co-analyzed to refine topics for an in-person roundtable where recommendations for system change were deliberated and drafted by 26 participants. Results Participants emphasized major issues in patient access to novel therapeutics including burdens of time, cost, and transportation required to complete eligibility requirements or to participate in trials. Only 12% of respondents reported satisfaction with current research systems, with "patient access to trials" and "delays in study approval" the topmost concerns. Conclusion Experts agree that an equity-centered precision oncology communication model should be developed to improve access to adaptive seamless trials, eligibility reforms, and just-in-time trial activation. International advocacy groups are a key mobilizer of patient trust and should be involved at every stage of research and therapy approval. Our results also show that governments can promote better and faster access to life-saving therapeutics by engaging researchers and payors in an ecosystem approach that responds to the unique clinical, structural, temporal, and risk-benefit situations that patients with life-threatening cancers confront.
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Affiliation(s)
- Kristin Bright
- Department of Anthropology, Middlebury College, Middlebury, VT, United States.,Department of Anthropology, University of Toronto, Toronto, ON, Canada
| | - Anneliese Mills
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | | | - David J Stewart
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
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Perez-Gracia JL, Penel N, Calvo E, Awada A, Arkenau HT, Amaral T, Grünwald V, Sanmamed MF, Castelo-Branco L, Bodoky G, Lolkema MP, Di Nicola M, Casali P, Giuliani R, Pentheroudakis G. Streamlining clinical research: an ESMO awareness call to improve sponsoring and monitoring of clinical trials. Ann Oncol 2023; 34:70-77. [PMID: 36209982 DOI: 10.1016/j.annonc.2022.09.162] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/22/2022] [Accepted: 09/28/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND During recent years, the burden of bureaucracy in clinical research has increased dramatically, adversely impacting the activity of investigators and clinical research teams. Although compliance with the Declaration of Helsinki, the guidelines for Good Clinical Practice (GCP), and other applicable regulations remains unquestionable, their overinterpretation and substitution by the internal operating procedures of sponsors and Contract Research Organizations (CROs) have increased the administrative burden. A survey conducted by the European Society for Medical Oncology (ESMO) Clinical Research Observatory (ECRO) among 940 investigators confirmed that they considered that the administrative burden in clinical research is excessive; that administrative procedures could be reduced without affecting the safety and the rights of the patients and the quality of the data; and that bureaucracy represents an obstacle for clinical research. METHODS A panel of physicians with extensive experience in clinical research, composed by members of the ECRO and the ESMO Scientific Medical and Public Policy divisions, analyzed clinical trial procedures related to administrative workflow, pharmacovigilance, and medical care. RESULTS The panel identified situations that generate debate between investigators and sponsors/CROs and selected real clinical scenarios that exemplify such situations. The panel discussed and proposed specific recommendations for those situations, based on GCP. CONCLUSIONS This initiative aspires to streamline clinical research procedures and to become a platform for discussion among all clinical trial stakeholders, with the aim of promoting the sustainability of clinical research and the care of cancer patients.
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Affiliation(s)
- J L Perez-Gracia
- Department of Oncology, University Clinic of Navarra and Health Research Institute of Navarra (IdiSNA), Pamplona, Spain.
| | - N Penel
- Centre Oscar Lambret and Lille University, Lille, France
| | - E Calvo
- START Madrid-CIOCC, Centro Integral Oncológico Clara Campal, Madrid, Spain
| | - A Awada
- Institut Jules Bordet, Université Libre de Bruxelles (Head of the Oncology Medicine Department), Brussels, Belgium
| | | | - T Amaral
- Division of Dermato-Oncology, Department of Dermatology, University of Tuebingen, Tuebingen, Germany; Cluster of Excellence iFIT (EXC 2180) 'Image Guided and Functionally Instructed Tumor Therapies', Tuebingen, Germany
| | - V Grünwald
- University Hospital Essen, Clinic for Medical Oncology and Clinic for Urology, Essen, Germany
| | - M F Sanmamed
- Department of Oncology, University Clinic of Navarra and Health Research Institute of Navarra (IdiSNA), Pamplona, Spain
| | - L Castelo-Branco
- Scientific and Medical Division, ESMO - European Society for Medical Oncology, 6900 - Lugano, Switzerland; NOVA National School of Public Health, NOVA University, Lisbon, Portugal
| | | | - M P Lolkema
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - M Di Nicola
- Immunotherapy and Innovative Therapeutics Unit, Oncology and Hematology Department Fondazione, IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - P Casali
- Fondazione IRCCS Istituto Nazionale Tumori and University of Milan, Milan, Italy
| | - R Giuliani
- The Clatterbridge Cancer Centre, Liverpool, UK
| | - G Pentheroudakis
- Scientific and Medical Division, European Society for Medical Oncology, Lugano, Switzerland
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Sayyid RK, Hiffa A, Woodruff P, Oberle MD, Lambert JH, Terris MK, Wallis CJD, Klaassen Z. Suspension of Oncology Randomized Clinical Trials during the COVID-19 Pandemic: A Cross-Sectional Evaluation of COVID-Related Suspensions. Cancer Invest 2022; 40:743-749. [PMID: 35852930 DOI: 10.1080/07357907.2022.2104305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We conducted a cross-sectional analysis of ClinicalTrials.gov-registered oncology randomized controlled trials between September 2019 and December 2021 to identify predictors of trial suspensions. The dataset included 1,183 oncology trials, of which 384 (32.5%) were suspended. COVID-19 accounted for 47 (12.2%) suspensions. Trials that were single center- or US-based had higher odds of COVID-19 (ORs: 3.85 and 2.48, 95% CIs: 1.60-11.50 and 1.28-4.93, respectively) or any-reason suspensions (ORs: 2.33 and 2.04, 95% CIs: 1.46-3.45 and 1.40-2.76, respectively). Phase two (OR 1.27), three (OR 6.45) and four trials (OR 11.5) had increased odds of COVID-19 suspensions, compared to phase one trials.
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Affiliation(s)
- Rashid K Sayyid
- Section of Urology, Department of Surgery, Augusta University, Augusta, GA, USA
| | - Anthony Hiffa
- Section of Urology, Department of Surgery, Augusta University, Augusta, GA, USA
| | - Phillip Woodruff
- Section of Urology, Department of Surgery, Augusta University, Augusta, GA, USA
| | - Michael D Oberle
- Section of Urology, Department of Surgery, Augusta University, Augusta, GA, USA
| | - Joshua H Lambert
- Section of Urology, Department of Surgery, Augusta University, Augusta, GA, USA
| | - Martha K Terris
- Section of Urology, Department of Surgery, Augusta University, Augusta, GA, USA.,Georgia Cancer Center, Augusta University, Augusta, GA, USA
| | | | - Zachary Klaassen
- Section of Urology, Department of Surgery, Augusta University, Augusta, GA, USA.,Georgia Cancer Center, Augusta University, Augusta, GA, USA
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Molecular oncology: what is needed to speed access to innovative therapies in clinical research? Curr Opin Oncol 2022; 34:575-578. [PMID: 35855513 DOI: 10.1097/cco.0000000000000880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW A better understanding of the biology of cancer cells has led in the past 20 years to more and more molecular and immunological driven treatment strategies impacting both clinical trials and day-to-day practice. The aim of this review is to describe new approaches to conduct clinical trials in this area to speed up drug development and increase access to innovation for cancer patients. RECENT FINDINGS The design of an early phase trial has an impact on its clinical benefit. Trials deriving from a specific biomarker or histologic characteristic (also known as enrichment design) are more likely to demonstrate benefit than trials based on a more conventional design. However, the increase of low incidence cancer molecular subtypes poses a major hurdle in the clinical management and drug development research for cancer patients. SUMMARY With the identification of news targets and the subsequent introduction of precision medicine, new strategies and tools are needed to provide access to biomarker identification and target-oriented clinical trials to all cancer patients. We propose to set up a new patient-centered model to conduct clinical trials allowing simply to 'bring the trial to the patient'.
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Castelo-Branco L, Tsourti Z, Gennatas S, Rogado J, Sekacheva M, Viñal D, Lee R, Croitoru A, Vitorino M, Khallaf S, Šušnjar S, Soewoto W, Cardeña A, Djerouni M, Rossi M, Alonso-Gordoa T, Ngelangel C, Whisenant JG, Choueiri TK, Dimopoulou G, Pradervand S, Arnold D, Harrington K, Michielin O, Dafni U, Pentheroudakis G, Peters S, Romano E. COVID-19 in patients with cancer: first report of the ESMO international, registry-based, cohort study (ESMO-CoCARE). ESMO Open 2022; 7:100499. [PMID: 35644101 PMCID: PMC9080222 DOI: 10.1016/j.esmoop.2022.100499] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/22/2022] [Accepted: 04/23/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND ESMO COVID-19 and CAncer REgistry (ESMO-CoCARE) is an international collaborative registry-based, cohort study gathering real-world data from Europe, Asia/Oceania and Africa on the natural history, management and outcomes of patients with cancer infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). PATIENTS AND METHODS ESMO-CoCARE captures information on patients with solid/haematological malignancies, diagnosed with coronavirus disease 2019 (COVID-19). Data collected since June 2020 include demographics, comorbidities, laboratory measurements, cancer characteristics, COVID-19 clinical features, management and outcome. Parameters influencing COVID-19 severity/recovery were investigated as well as factors associated with overall survival (OS) upon SARS-CoV-2 infection. RESULTS This analysis includes 1626 patients from 20 countries (87% from 24 European, 7% from 5 North African, 6% from 8 Asian/Oceanian centres), with COVID-19 diagnosis from January 2020 to May 2021. Median age was 64 years, with 52% of female, 57% of cancer stage III/IV and 65% receiving active cancer treatment. Nearly 64% patients required hospitalization due to COVID-19 diagnosis, with 11% receiving intensive care. In multivariable analysis, male sex, older age, Eastern Cooperative Oncology Group (ECOG) performance status ≥2, body mass index (BMI) <25 kg/m2, presence of comorbidities, symptomatic disease, as well as haematological malignancies, active/progressive cancer, neutrophil-to-lymphocyte ratio (NLR) ≥6 and OnCovid Inflammatory Score ≤40 were associated with COVID-19 severity (i.e. severe/moderate disease requiring hospitalization). About 98% of patients with mild COVID-19 recovered, as opposed to 71% with severe/moderate disease. Advanced cancer stage was an additional adverse prognostic factor for recovery. At data cut-off, and with median follow-up of 3 months, the COVID-19-related death rate was 24.5% (297/1212), with 380 deaths recorded in total. Almost all factors associated with COVID-19 severity, except for BMI and NLR, were also predictive of inferior OS, along with smoking and non-Asian ethnicity. CONCLUSIONS Selected patient and cancer characteristics related to sex, ethnicity, poor fitness, comorbidities, inflammation and active malignancy predict for severe/moderate disease and adverse outcomes from COVID-19 in patients with cancer.
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Affiliation(s)
- L Castelo-Branco
- Scientific and Medical Division, ESMO (European Society for Medical Oncology), Lugano, Switzerland; NOVA National School of Public Health, NOVA University, Lisbon, Portugal
| | - Z Tsourti
- Frontier Science Foundation-Hellas, Athens, Greece
| | - S Gennatas
- Medical Oncology Department, The Royal Marsden Hospital - NHS Foundation Trust, London, UK
| | - J Rogado
- Medical Oncology Department, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - M Sekacheva
- World-Class Research Center 'Digital Biodesign and Personalized Healthcare', Sechenov First Moscow State Medical University, Moscow, Russia
| | - D Viñal
- Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain
| | - R Lee
- Medical Oncology Department, The University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK
| | - A Croitoru
- Medical Oncology Department, Fundeni Clinical Institute, Bucharest, Romania
| | - M Vitorino
- Servico Oncologia, Hospital Prof. Dr Fernando Fonseca EPE (Hospital Amadora/Sintra), Amadora, Portugal
| | - S Khallaf
- Medical Oncology Department, South Egypt Cancer Institute (SECI), Assiut University, Assiut, Egypt
| | - S Šušnjar
- Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - W Soewoto
- Department of Surgery, Oncology Division, Sebelas Maret University, Surakarta, Indonesia
| | - A Cardeña
- Medical Oncology Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - M Djerouni
- Oncology Department, Dr Saadane Hospital, Biskra, Algeria
| | - M Rossi
- Oncology Deparment, ASO 'SS. Antonio, Biagio e Cesare Arrigo', Alessandria, Italy
| | - T Alonso-Gordoa
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - C Ngelangel
- Asian Cancer Institute - Asian Hospital and Medical Center, Metro Manila, the Philippines
| | - J G Whisenant
- Vanderbilt University Medical Center, Nashville, USA
| | - T K Choueiri
- The Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, USA; Harvard Medical School, Boston, USA
| | - G Dimopoulou
- Frontier Science Foundation-Hellas, Athens, Greece
| | - S Pradervand
- Oncology Department, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - D Arnold
- Oncology, Haematology, Palliative Care Department, Asklepios Klinik Altona - Asklepios Kliniken, Hamburg, Germany
| | - K Harrington
- Division of Radiotherapy and Imaging, The Royal Marsden/The Institute of Cancer Research NIHR Biomedical Research Centre, London, UK
| | - O Michielin
- Oncology Department, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - U Dafni
- Laboratory of Biostatistics, School of Health Sciences, National and Kapodistrian University of Athens, Athens Frontier Science Foundation-Hellas, Athens, Greece
| | - G Pentheroudakis
- Scientific and Medical Division, ESMO (European Society for Medical Oncology), Lugano, Switzerland
| | - S Peters
- Department, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - E Romano
- Center for Cancer Immunotherapy, Department of Oncology, PSL Research University, Institut Curie, Paris, France.
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Beretta GD, Casolino R, Corsi DC, Perrone F, Di Maio M, Cinieri S, Gobber G, Bellani M, Petrini F, Zocchi MT, Traclò F, Zagonel V. Position paper of the Italian Association of Medical Oncology on the impact of COVID-19 on Italian oncology and the path forward: the 2021 Matera Statement. ESMO Open 2022; 7:100538. [PMID: 35921761 PMCID: PMC9222406 DOI: 10.1016/j.esmoop.2022.100538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 06/08/2022] [Indexed: 11/03/2022] Open
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Basu Roy U, Baird AM, Ciupek A, Fox J, Manley E, Norris, XX K, Scagliotti GV, Wakelee HA, Mitsudomi T, Clark RC, Arndt R, Hirsch FR, Bunn PA, Smeltzer MP. Impact of the Coronavirus Disease 2019 Pandemic on Global Lung Cancer Clinical Trials: Why It Matters to People With Lung Cancer. JTO Clin Res Rep 2022; 3:100269. [PMID: 34961851 PMCID: PMC8695593 DOI: 10.1016/j.jtocrr.2021.100269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/11/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
| | | | - Andrew Ciupek
- GO2 Foundation for Lung Cancer, Washington, District of Columbia
| | - Jesme Fox
- Roy Castle Lung Cancer Foundation, Liverpool, United Kingdom
| | | | | | | | | | | | | | - Renee Arndt
- Cancer Technology Applications, LLC, San Diego, California
| | - Fred R. Hirsch
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Paul A. Bunn
- University of Colorado School of Medicine, Aurora, Colorado
| | - Matthew P. Smeltzer
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, Tennessee
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Martínez MT, Moragon S, Ortega-Morillo B, Montón-Bueno J, Simon S, Roselló S, Insa A, Viala A, Navarro J, Sanmartín A, Fluixá C, Julve A, Soriano D, Buch E, Peña A, Franco J, Martínez-Jabaloyas J, Marco J, Forner MJ, Cano A, Silvestre A, Teruel A, Bermejo B, Cervantes A, Chirivella Gonzalez I. Impact of the COVID-19 Pandemic on a Cancer Fast-Track Programme. Cancer Control 2022; 29:10732748221131000. [DOI: 10.1177/10732748221131000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction The COVID-19 pandemic has disrupted many aspects of clinical practice in oncology, particularly regarding early cancer diagnosis, sparking public health concerns that possible delays could increase the proportion of patients diagnosed at advanced stages. In 2009, a cancer fast-track program (CFP) was implemented at the Clinico-Malvarrosa Health Department in Valencia, Spain with the aim of shortening waiting times between suspected cancer symptoms, diagnosis and therapy initiation. Objectives The study aimed to explore the effects of the COVID-19 pandemic on our cancer diagnosis fast-track program. Methods The program workflow (patients included and time periods) was analysed from the beginning of the state of alarm on March 16th, 2020 until March 15th, 2021. Data was compared with data from the same period of time from the year before (2019). Results During the pandemic year, 975 suspected cancer cases were submitted to the CFP. The number of submissions only decreased during times of highest COVID-19 incidence and stricter lockdown, and overall, referrals were slightly higher than in the previous 2 years. Cancer diagnosis was confirmed in 197 (24.1%) cases, among which 33% were urological, 23% breast, 16% gastrointestinal and 9% lung cancer. The median time from referral to specialist appointment was 13 days and diagnosis was reached at a median of 18 days. In confirmed cancer cases, treatment was started at around 30 days from time of diagnosis. In total, 61% of cancer disease was detected at early stage, 20% at locally advanced stage, and 19% at advanced stage, displaying time frames and case proportions similar to pre-pandemic years. Conclusions Our program has been able to maintain normal flow and efficacy despite the challenges of the current pandemic, and has proven a reliable tool to help primary care physicians referring suspected cancer patients.
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Affiliation(s)
- M. T. Martínez
- Department of Medical Oncology Department, Hospital Clínico Universitario, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain
| | - S. Moragon
- Department of Medical Oncology Department, Hospital Clínico Universitario, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain
| | - B. Ortega-Morillo
- Department of Medical Oncology Department, Hospital Clínico Universitario, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain
| | - J. Montón-Bueno
- Department of Medical Oncology Department, Hospital Clínico Universitario, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain
| | - S. Simon
- Department of Medical Oncology Department, Hospital Clínico Universitario, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain
| | - S. Roselló
- Department of Medical Oncology Department, Hospital Clínico Universitario, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain
- Department of Medical Oncology, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain
- Instituto de Salud Carlos III, CIBERONC, Madrid, Spain
| | - A. Insa
- Department of Medical Oncology Department, Hospital Clínico Universitario, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain
| | - A. Viala
- Department of Medical Oncology Department, Hospital Clínico Universitario, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain
| | - J. Navarro
- Management Department, Hospital Clinico Universitario de Valencia, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain
- CIBERESP (CIBER de Epidemiología y Salud Pública), Centro Nacional de Epidemiología Del Instituto de Salud Carlos III, Madrid, Spain
| | - A. Sanmartín
- Management Department, Hospital Clinico Universitario de Valencia, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain
| | - C. Fluixá
- Alfahuir Primare Care Center, Valencia, Spain
| | - A. Julve
- Department of Radiodiagnosis, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain
| | - D. Soriano
- Department of Radiodiagnosis, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain
| | - E. Buch
- Department of Surgery, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain
| | - A. Peña
- Department of Medicine Digestive, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain
| | - J. Franco
- Department of Pneumology, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain
| | - J. Martínez-Jabaloyas
- Department of Urology, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain
| | - J. Marco
- Department of Otolaryngology, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain
| | - M. J. Forner
- Department of Internal Medicine, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain
| | - A. Cano
- Department of Gynaecology, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain
| | - A. Silvestre
- Department of Traumatology, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain
| | - A Teruel
- Department of Haematology, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain
| | - B. Bermejo
- Department of Medical Oncology Department, Hospital Clínico Universitario, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain
- Department of Medical Oncology, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain
- Instituto de Salud Carlos III, CIBERONC, Madrid, Spain
| | - A. Cervantes
- Department of Medical Oncology Department, Hospital Clínico Universitario, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain
- Department of Medical Oncology, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain
- Instituto de Salud Carlos III, CIBERONC, Madrid, Spain
| | - I. Chirivella Gonzalez
- Department of Medical Oncology Department, Hospital Clínico Universitario, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain
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