By Evangelia Razis, MD, PhD
The COVID-19 pandemic was unique in human history in that it exposed how intricately interconnected we are at a global level. In fact, there was a period where every single country had cases of COVID-19 infection and, as a reaction, had closed its borders. A very swift reaction led to the quick development of effective vaccinations followed by their rapid approval and implementation.
However, one could argue that cancer, in its own way, has been a worldwide pandemic for decades already, claiming lives in every part of the world at steadily growing rates. So maybe we can learn from the concerted, collaborative efforts against COVID-19 during this last year that international health issues can and should be approached collaboratively. In that regard, the international oncology community should prioritize and tackle issues at a global level to prevent the loss of more lives to cancer.
Some such issues include, first and foremost, cancer prevention, starting with tobacco and obesity control. The burden of non-communicative diseases is constantly rising both in high-income and low-middle and low-income countries at a disturbing pace. Global action in tackling these two pandemics could have a huge impact in cancer incidence worldwide.
A significant issue that puts immense pressure on all societies is the constantly rising costs of medication, leading to dramatic inequalities in access to state-of-the-art cancer care. It is not rare these days for new anticancer agents’ costs to surpass $20,000 per patient per month. And though the global oncology community should put a limit to drug costs, we also need to contribute by curtailing the waste that happens every day in oncology practices through unnecessary, excessive, and sometimes even harmful tests and therapies. "Less is more" was one of the resounding lessons of the COVID-19 experience.
Yet another lesson learned that may be useful in the cancer continuum is the swift conduct of clinical trials and processing of approvals. Although many fear this could lead to premature release of medications in the community and reduce our ability to detect safety issues with new medications before patients are exposed to them, it also allows us to see how tedious and slow the clinical trial conduct and drug approval process has become under normal circumstances. In the name of safeguarding patient safety, privacy, and rights, the processes have become extremely slow and bureaucratic and, to make matters worse, expensive.
We have also learned that our health care systems’ capacity in terms of beds and personnel can be overwhelmed thus preparation and caution in unexamined excessive use of the health care system is not just a low-income country imperative. Low-income countries struggle under the weight of the rising cancer incidence, and now high-income countries understand what a maxed-out health care system can lead to. Clearly, when it comes to cancer care, we all need to contribute to enhancing the potential of the health care systems.
Lastly, in this past year we realized that hard choices are ingrained in the practice of medicine. But equity also is inseparable from the ethical practice of medicine, and one area where equitable care must always be provided is palliation. Appropriate palliative care should be available to all patients with cancer worldwide, and it simply isn’t in most countries. This, too, is an issue to be prioritized.
The tragic events of 2020 shook the human race with unprecedented force, disturbing many aspects of our lives we all took for granted, such as visiting our aging parents, hugging our loved ones, being with family members close to their deaths, going to work, going to school, and traveling. Cancer care was affected as patients saw lifesaving surgery being postponed because of COVID-19 precautions or therapies being put on hold. And as we learned not to take things for granted, we also learned how to work together to get results quickly and defend ourselves against a common enemy. The cancer community needs to take advantage of the momentum created by this solidarity and make use of it to improve the predicament of patients with cancer worldwide.
Dr. Razis is a member of ASCO’s International Affairs Committee and the director of the 3rd Oncology Department and Contemporary Oncology Team at the Hygeia Hospital in Athens, Greece. Disclosure.
COVID-19 Resources from ASCO
- American Society of Clinical Oncology Road to Recovery Report: Learning From the COVID-19 Experience to Improve Clinical Research and Cancer Care
- Coronavirus and COVID-19: What People With Cancer Need to Know
- COVID-19 Impact and Perspectives from the International Affairs Committee
- COVID-19 Vaccine and Patients With Cancer
- Delivering Cancer Care During the COVID-19 Pandemic: Recommendations and Lessons Learned From ASCO Global Webinars