AACR Calls for More Funding for Basic Research and Telehealth Equity

The COVID-19 pandemic that became evident in the U.S. in early 2020 had a profound and disruptive effect upon cancer research and treatment, but the lessons learned can be used to improve healthcare delivery in multiple indications, according to the AACR Report on the Impact of COVID-19 on Cancer Research and Patient Care, which was released Wednesday (February 9th).

The American Association for Cancer Research (AACR) shared a few highlights from that report in a virtual Congressional Briefing before discussing ways the lessons learned during the pandemic can improve cancer research and patient care in the future. Here are some of the patient-related findings:

• Patients with hematologic cancers and those receiving B cell-targeted therapies may not benefit from COVID-19 vaccines.
• Patients missed nearly 10 million cancer screenings during the first six months of 2020.
• The number of people diagnosed with inoperable or metastatic cancer increased 11% March through December 2020, compared to 2019.
• Delays in screening, diagnosis and treatment contributed to negative outcomes and poorer mental health and disproportionately affected underserved populations and racial and ethnic populations.

Cancer researchers were affected, too. Of the 66 AACR grant recipients surveyed:

• 99% said the pandemic harmed their research, career or patient care.
• 87% said they were less productive.
• 61% said the pandemic delayed their career advancement.

That said, “Decades of National Institutes of Health (NIH)-funded research in mRNA vaccines for cancer paved the way to develop mRNA vaccines for COVID-19 in record time. This reenergized mRNA development,” Antoni Ribas, M.D., Ph.D., FAACR, said during the briefing. Ribas chaired the steering committee for this report and the AACR COVID-19 and Cancer Task Force, and is the immediate past president of AACR.

“One of the most valuable lessons that emerged was that cancer immunotherapy can be just as effective when delivered in larger doses but less frequently, which is more convenient for patients,” Ribas said. The community also learned the value of designing cancer trials to enable partnering with local clinics. “This could decrease trial costs and increase patient access to trials.”

Cancer survivor Larry Saltzman, M.D., honed the point by citing his own experience. “I live in northern California and travel to Seattle for treatment (for a blood-based cancer).” COVID-19 made it impossible for him to return to Seattle every three months, “so I was lost to follow-up for 18 months. An MRI, CT or PET scan is as good in California as in Seattle, however. Clinical trials should be formatted so they can be followed wherever patients are located. Location shouldn’t be a barrier.”

The speakers extolled the benefits of telehealth while noting the challenges posed by a lack of high-speed Internet in some parts of the country. “Telemedicine use was 38 times higher in July 2021 than before the pandemic,” Ana Maria Lopez, M.D., professor and vice-chair, medical oncology, Sidney Kimmel Medical College, said. “For patients with cancer, 45% preferred a tele-visit and 34% preferred an in-person visit.”

The reasons for the tele-visit preference included reduced travel time and high-quality counseling. Cancer survivor Allie Pile added that telemedicine reduced her risk of contracting other diseases, which is important for immuno-compromised patients.

“The pandemic laid bare inequities in care,” Lopez said. Telehealth, the speakers agreed, also has the capability to extend preventive care and access to clinical trials to minority and underserved populations, thereby increasing the diversity of trial participants.

“There are still thousands of people with undetected cancer because they aren’t getting preventive care,” Senator Amy Klobuchar, (D-MN), said in a brief presentation. Last October, “I introduced the (bipartisan) Preventive Care Awareness Act  with Senator Susan Collins (R-ME) to address disparities in these services.”

U.S. Senator Roy Blunt (R-Missouri) followed Senator Klobuchar in the briefing by calling for continuing the type of public/private partnerships that enabled U.S. companies to develop COVID-19 therapeutics, vaccines and diagnostics so quickly during the pandemic.

“The RADx model (similar to Shark Tank) may be the most important concept to emerge from the pandemic. If you see an opportunity, active collaboration between the federal government and the private sector – with funding – can create breakthroughs in record time.” Under RADx, 716 ideas were presented and 32 diagnostic tests had advanced to Phase II development by May 2021, Blunt said, advocating more such partnerships.

For fiscal year 2022, AACR recommended additional funding for basic science to help overcome the challenges the pandemic revealed. Specifically, it called for providing:

• $10+ billion to the NIH in emergency supplemental funding to offset pandemic-related research costs.
• An additional $3.5 billion to the NIH and $1.1 billion to the National Cancer Institute (NCI), for total funding of $46.4 billion to the NIH and $7.6 billion to the NCI.
• An extra $343 million in discretionary funds for the U.S. Food and Drug Administration regulatory science initiatives and to advance the development of oncology products.

Other AACR recommendations included:

• Broadening healthcare coverage, including Medicaid, to reduce inequities.
• Permanently extending the Centers for Medicare & Medicaid Services-approved telehealth services, and improving telehealth services by implementing nationwide high-speed internet that reaches underserved areas.
• Increasing diversity in clinical trials and alleviating the financial burden on prospective trial participants by reimbursing patients for ancillary trial-related costs, such as transportation and lodging, as contained in the Diverse Act.

There is more to addressing healthcare inequities than improving access and funding, Lopez acknowledged. “The pandemic really impacted confidence in science.” To counter the misinformation and disinformation, “The biggest recommendation (for healthcare professionals) is to be trustworthy. Communicate clearly with patients, their families, caregivers and the community, and engage with communities. Be transparent, and remain independent from political pressure.”

The goal, Lopez said, is to be prepared for the next pandemic.