#EAPM – Cancer care under COVID-19

Welcome, one and all, to the first update of the week from the European Alliance for Personalised Medicine (EAPM). We hope that a large proportion of you are now enjoying your August break as best as possible, and we all look forward to seeing how the continent’s schools will cope as best they can with the return to lessons in September. A serious issue today is how cancer patients have fared in terms of access to treatment during COVID-19 – first, on with the EU health round-up, writes EAPM Executive Director Denis Horgan.

State of the Union

On 16 September, Commission President Ursula von der Leyen will deliver her first State of the Union speech. How the EU has strived to bring the coronavirus pandemic under control will certainly be writ large, and it is likely, concerning health generally, von der Leyen will talk about how the original €9.4 billion EU4Health proposal, which was her own plan, was rejected by the Council, which chose instead a more frugal €1.7bn plan.

Commission approves €100 million Slovenian scheme on coronavirus

The European Commission has approved a €100 million Slovenian scheme to support companies affected by the coronavirus outbreak, as well as research and development (R&D) and production of coronavirus-relevant products. The scheme was approved under the state aid Temporary Framework. It is composed of four measures. Under the first two measures, the public support will take the form of direct grants and loans with zero interest rate, respectively, and will be open to small and medium-sized companies registered in the national Business Register. The aim of the measures is to help those companies counter the liquidity shortages they face due to the coronavirus outbreak. The other two measures aim at enhancing and accelerating R&D projects and the production of products that are relevant to the coronavirus outbreak. The public support, which will take the form of direct grants, will be open to companies of all sizes.

EunetHTA on coronavirus remedies

Following the outbreak of the corona pandemic, the EU Directorate of Health called on the EUnetHTA partners to make a scientific commitment to combating the pandemic. Two types of Corona tests RT-PCR test: Rapidly after the outbreak of the corona pandemic, researchers developed methods to detect the virus directly. For this purpose, a smear is taken from the mouth, nose or throat area and examined for genetic traces of the virus. This method is known under the abbreviation RT-PCR and has a high accuracy. However, a few days after infection the body reacts to the virus. If the body's immune defense fights and destroys the virus, it is difficult or impossible to detect it with the RT-PCR test. Antibody test: This second type of coronavirus test measures the body's immune response. The antibodies produced by the body are detected—usually by measuring the immunoglobulins M and G. Since the body needs several days to produce a measurable immune response, antibody tests only react with a strong delay after an infection. Antibody tests for the coronavirus are therefore too slow to detect or rule out an acute infection when relevant symptoms occur.

Belgian COVID-19 centre shifts to Brussels

Mask-wearing was brought in last week for 1.2 million people living in the Brussels region as Belgium battled one of the most serious coronavirus outbreaks in Europe. Belgium has the highest per capita death rate from COVID-19 in the world and infections are rising again after earlier success in bringing the disease under control. The number of cases in the country of about 11.5 million people neared 78,000 on Sunday (16 August). Close to 10,000 deaths have been registered.

Sweden COVID-19 strategist under fire

Anders Tegnell, the architect of Sweden’s has repeatedly insisted the government’s objective was not to achieve rapid herd immunity but rather to slow the spread of the coronavirus enough for health services to be able to cope. However, email exchanges obtained by Swedish journalists under freedom of information laws show Tegnell discussing herd immunity as an objective in mid-March, days after the World Health Organization declared COVID-19 a pandemic, and further suggesting that elderly deaths might be justifiable if her immunity could be achieved.

Commission reaches first agreement on potential vaccine

The European Commission has reached a first agreement with the pharmaceutical company AstraZeneca to purchase a potential vaccine against COVID-19 as well as to donate to lower and middle income countries or re-direct to other European countries. This is following the positive steps regarding the conclusion of exploratory talks with Sanofi-GSK announced on 31 July and with Johnson & Johnson on 13 August. Once the vaccine has proven to be safe and effective against COVID-19, the Commission has now agreed the basis for a contractual framework for the purchase of 300 million doses of the AstraZeneca vaccine, with an option to purchase 100 million more, on behalf of EU member states. The Commission continues discussing similar agreements with other vaccine manufacturers.

Quarantine updates

People traveling to England from France, the Netherlands, Monaco, Malta, the Turks and Caicos Islands and Aruba will have to self-isolate for two weeks starting at 4 a.m. Saturday (15 August), the British government has said.

Cancer care under COVID-19

During this tumultuous period of COVID-19 infection, the oncology community is facing unprecedented challenges. According to reports in the UK, British people are now more likely to die of cancer than 15 years ago because of coronavirus and, according to the American Cancer Society, this year nearly 5,000 new cases of cancer will be diagnosed per day in the United States. Initial reports suggest that COVID-19 can be particularly lethal in patients with cancer. It is known that COVID-19 disproportionately harms elderly persons and those with comorbid conditions.

Robust outcomes evidence supporting a decision to initiate or delay cancer care is often lacking. Recommendations in this figure are consensus-based and should be used as a general guideline only. Expert oncologic opinion tailored to individual patient and local health system conditions should always be obtained.

According to researchers in England, disruption to diagnostic services and patients avoiding health care because of COVID-19 could see around 3,500 potentially avoidable deaths from the four main cancers in England, warn researchers. Urgent policy interventions were needed to deal with the backlog of patients awaiting routine diagnostic services and to reduce the cancer death toll attributable to the Covid-19 crisis. Researchers called for public health messaging that puts the risk of severe illness from Covid-19 into perspective compared with not seeking health-care advice for symptoms of cancer. In addition, they urged evidence-based information to help health-care workers manage the risks for patients with suspected cancer, as well as increasing both routine and urgent diagnostic capacity.

The UK modelling research, published in The Lancet oncology journal, suggests 3,291 to 3,621 lives could be lost to breast, colorectal, oesophageal, and lung cancer over next five years due to delays. Another UK study has found that, for many cancers, delays to treatment of two to six months will lead to a substantial proportion of patients with early-stage tumours progressing from curable to incurable disease. During lockdown to combat the coronavirus pandemic, cancer screening and routine outpatient referral pathways were suspended, noted the London- based researchers behind the first study. The only route to diagnosis was via an urgent two-week GP referral or presenting to an emergency department. Since physical distancing measures came in on 16 March, urgent referrals have fallen by as much as 80%.

However, according to Professor Bogda Koczwara, from the Flinders Health and Medical Research Institute Cancer in Australia, the COVID-19 pandemic is an opportunity to expand cancer survivorship services by maintaining and building better digital and telehealth systems. The pandemic presents a once-in-a-generation opportunity to consolidate and refine the content, method and appropriate use of multiple technologies in health care in general and in cancer survivorship, says Koczwara.

And that is all for now – stay safe, stay well, and see you at the end of the week.

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