ASCO Releases Recommendations for Postpandemic Cancer Care

The American Society of Clinical Oncology (ASCO) released a set of recommendations to congress, the administration, and the health care community to guide the cancer community’s post-pandemic recovery. Longstanding disparities in health care have been highlighted and exacerbated by the pandemic, and the recommendations in the report, published in ASCO’s Journal of Clinical Oncology, aim to make cancer care accessible to and equitable for patients in all communities.

ASCO established volunteer task forces of member physicians, cancer care professionals, and patient advocates to pool knowledge and form recommendations in both the clinical and research settings. Task forces worked to understand the pandemic’s effects on cancer care and research; evaluating government, health plan, and care provider responses to the public health emergency.

The report comes at a time when the future is still uncertain, but at a point where the oncology community has demonstrated its ability to adapt in the face of new pressures felt by all stakeholders in health care.

One notable way that physicians and the Centers for Medicare & Medicaid Services adapted to the “new normal” was the implementation and coverage of telehealth, which helped minimize patient exposure in cases when a virtual check-in could be just as effective as an in-person conversation. Now, it has the potential to continue to save patients time and reduce costs, both in the clinical and research settings. Making the expanded coverage of telehealth is one initiative in the new report.

“Really quickly, it was clear that telehealth could work, and that we actually could ship pills to patients and have them get labs locally and fax them over, which then ended up being something we found could apply to some of the clinical trial settings,” Howard A. Burris, MD, FACP, FASCO, and ASCO immediate past president, told The American Journal of Managed Care® (AJMC®).

While many cancer drugs require visits for infusions, many new therapies are oral medications for targeted mutations. Monitoring those patients via telehealth and integrating electronic medical record platforms has allowed for quality care, even with less in-person visits. And more time at home, Burris noted, means more support from family members or caretakers who would not be able to accompany patients to in-person visits during the pandemic.

Despite the benefits of telehealth, its use has also highlighted the disparity between patients with access to the internet connection and software necessary to participate in it and those who do not, Burris noted. Disparities related to financial situations, social situations, and race have also been highlighted.

When it comes to clinical trials, Burris cites the slightly relaxed, more practical eligibility criteria deemed necessary during the pandemic to be something that should continue.

“ASCO has been working on trying to improve clinical trial accrual, which will speed new therapies being developed. If we can have more practical eligibility criteria, and we can take some of the burden off the patients with regard to travel and effort,” Burris said, “We're actually putting people on clinical trials who more appropriately mirror what's out there in our society.”

In the report, ASCO calls on researchers, trial sponsors, and regulators to work toward a more accessible system for patients that would be more resilient and flexible than the current standard, including steps like the continuation of remote and virtual approaches to consent agreements and other trial procedures and better integrating trials into routine cancer care. The recommendations also suggest increasing trial efficiency by streamlining and standardizing regulatory and training requirements and using central Institutional Review Boards and innovative trial designs.

Policymakers, payers, clinicians, and others are urged to continue building on strategies that have helped patients receive necessary care during the pandemic. The report recommends increasing care access and equity through measures such as continued coverage of telemedicine, preventing Medicaid cuts, and ensuring that patients have access to affordable and comprehensive insurance.

Especially during a public health emergency, patient safety also comes into play. In that regard, recommendations include new chemotherapy infection control standards that account for viral threats, reliable access to personal protective equipment and vaccines, and limiting home infusions of chemotherapy to outstanding circumstances.

The full recommendations span a variety of goals that are noted in the report.

Goals for the clinical research space:

1. Ensure that clinical research is accessible, affordable, and equitable
2. Design more pragmatic and efficient clinical trials
3. Minimize administrative and regulatory burdens on research sites
4. Recruit, retain, and support a well-trained clinical research workforce
5. Promote appropriate oversight and review of clinical trial conduct and results

Goals for the cancer care delivery space:

1. Promote and protect equitable access to high-quality cancer care
2. Support safe delivery of high-quality cancer care
3. Advance policies to ensure oncology providers have sufficient resources to provide high-quality patient care
4. Recognize and address threats to clinician, provider, and patient well-being
5. Improve patient access to high-quality cancer care via telemedicine

Overall, the recommendations aim to ensure that the atmosphere in oncology reflects the ideals that ASCO president Lori Pearce, MD, prioritized long before the crisis when she announced the theme of her presidential term: "Equity: Every Patient. Every Day. Everywhere."

"Some of the effects of the pandemic really brought disparities to light and created an additional level of energy around this task force proposing changes going forward," Burris said.

Reference

Pennell NA, Dillmon M, Levit LA, et al. American Society of Clinical Oncology Road to Recovery Report. J Clin Oncol. Published online December 8, 2020. Accessed December 8, 2020. doi:10.1200/JCO.20.02953