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Cancer & COVID-19: a delicate balancing act - An interview with Antonella Cardone

Antonella Cardone was one the speakers of the virtual event "Balancing the reality of the pandemic’s budgets and the ongoing needs of cancer patients", organised by the EFPIA Oncology Platform.

The pandemic is hitting cancer patients hard. Weakened by their illness or immunocompromised due to treatment, they are extremely vulnerable if infected. Even those who avoid the virus are affected as screening, chemotherapy and surgery are postponed.

Antonella Cardone, Director, European Cancer Patients Coalition (ECPC) explains why patients and their doctors will need to balance the risk of visiting clinics against the risk of not being treated. And she offers her view on how the pandemic will shift European health policy, potentially triggered debate on EU Treaty change.

What do we know about the impact of COVID-19 on cancer patients?
In Italy, one in five of those who died had cancer. The indirect impact could be even greater. A study by University College London found that the pandemic will result in a 20% rise in the number of deaths among people with cancer – that’s 18,000 additional fatalities in England alone. Patients are missing out on screening, on follow-up appointments and many are nervous about attending clinics for treatment.

Even before the pandemic, we have been working with others to put the spotlight on cancer-related complications and comorbidities. Many people living with cancer are dealing with several conditions at once, making them particularly vulnerable.

What is your advice to patients?
We have worked with a group of 45 physicians from 26 countries to provide patients with up-to-date information and support on how to manage their condition during the pandemic. The text is available in 25 languages and has been accepted for publication in The Lancet.
The key message for patients is to rely on their doctor’s advice. The current recommendations will also change depending on how the pandemic evolves and evidence is gathered on the impact of the infection on cancer patients. During the different phases of the pandemic the risk-benefit assessment shifts.

Should all contact with health services be suspended under the pandemic ends?
It really depends on the reason for visiting the health service. For instance, we currently recommend that adjuvant chemotherapy be rescheduled, but life-saving chemotherapy should be maintained if at all possible. Again, doctors will advise their patients, taking everything into account. Where possible, we recommend consulting with doctors by phone or using telemedicine tools rather than visiting clinics.

For surgery, emergencies and aggressive tumours should be prioritised. Some radiotherapy may also be considered urgent and could proceed if disinfecting protocols are followed to ensure equipment is safe.

As we move into the next phases of the pandemic, we need to look at how we can get screening back on track. It will also be important to restart clinical trials once appropriate safety measures are in place.

How have industry partnerships helped to maintain care?
Several companies have shown solidarity with cancer patients by offering support both at European level and at national level. This has helped some of our members living in the most difficult situations.

Are you concerned that the looming economic crisis will exacerbate inequality in accessing cancer treatment?
Some commentators worry that investment in chronic conditions will be reduced as the focus shifts towards infectious diseases, or that we will see less health spending overall. I am more optimistic. I expect investment in managing infections and long-term care to increase. Health systems will emerge stronger from the pandemic – the lesson of this experience will be that healthy populations, and effective health systems, produce wealth. 

Targeted investment is more important than ever. As part of the All.Can initiative, we are looking to identify inefficiencies in the cancer pathway to reduce waste and optimise cancer care.

What other lessons will Europe learn from the pandemic?
I expect to see the EU make better use of its existing mandate to enhance coordination in the short term. In the longer term, taking a more strategic view, there is a clear case for Treaty change to increase competence in health at European level. 

It all comes down to ensuring that all EU citizens have the same right to health regardless of which Member State they live in. That requires a common strategy, with a more homogenised approach to budgeting and investment. From there, we can work towards the highest standards of prevention and care for all.

At present, access to cancer medicines varies widely. Would this improve in the scenario you envisage?
Today, a medication can be authorised centrally by the European Medicines Agency but then assessed separately by Health Technology Assessment (HTA) bodies in each country. This determines whether the drug is reimbursed and, essentially, decides whether patients have access.

As a result, we see patients in Germany getting a breast cancer drug soon after it has been approved by the EMA, but patients in neighbouring Denmark waiting seven years, and patients in Romania waiting 12 years longer than those in Germany. This is unbearable. For people with cancer, waiting years for the right treatment is a matter of life and death.  
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