Cancer patients must not become collateral damage in fight against pandemic

COVID-19 has created a crisis for Canadian cancer patients, who have faced extraordinary uncertainty —beginning with surgery delays last March that impacted hundreds of thousands of people and cancelled up to 38 per cent of all cancer surgeries. If we are to minimize the now well-documented burdens of COVID-19 on cancer patients, governments must support innovations that improve their outcomes and cut through the healthcare roadblocks posed by the pandemic. Health Minister Hajdu’s supplementary mandate letter recognized the broader COVID-19 related barriers to overall health care across the country and committed to working with provinces and territories to “expand capacity to deliver virtual health care, critical health and mental health resources and services.” This was a welcome signal that innovation is being sought to try to minimize the collateral damage of COVID-19 throughout the health system. A critical aspect of this is virtual consults and alternatives to in-clinic care. But other innovative solutions already exist, including for cancer patients—these innovations need only be embraced. For thousands of cancer patients each year, some traditional surgical biopsies can be replaced by a minimally invasive blood draw to enable oncologists to select targeted treatment options and monitor disease progression. This simple blood test and resulting treatments can improve patients outcomes up to three times and save lives, while likely saving the health system millions, addressing the surgery backlogs resulting from COVID-19, and can be done without going into hospital or medical clinic. Known as circulating tumour DNA (ctDNA) testing, this technology is widely deployed throughout the United States, but is not yet standard of care in Canada. In exceptional cases, Canadian patients who are able to access this testing through an oncologist must wait for blood samples to be shipped over the border, analyzed in U.S. labs, and then for results to arrive weeks later. This scenario costs thousands of dollars per patient and is not accessible to all Canadian patients who would benefit. With a strategic investment from Canada’s Digital Supercluster, a pilot project to bring ctDNA testing into the Canadian health system has been underway since July 2020, reaching more than 1,000 cancer patients to date with advanced breast, lung, and colorectal cancer. The ability to conduct the blood test at a local laboratory broadens access to rural and underserved populations, removing geography as a barrier to informed cancer treatment decisions. Such testing also keeps high-risk patients out of hospitals and other healthcare settings that could further compromise their health. This federally funded pilot project has demonstrated that access to blood-based testing should be expanded throughout Canada to become a first-line alternative to surgical procedures whenever medically indicated. Again, this is faster, less invasive, involves minimal social contact, and will save lives compared to traditional biopsies that yield comparable results. Prior to the pandemic, cancer was already the leading cause of death in Canada. According to Government of Canada statistics, each year more than 200,000 Canadians are diagnosed and 80,000 will die from the disease. Moreover, trend lines indicate these numbers will rise in coming years—not only due to COVID-19 backlogged surgeries, but also due to delays in subsequent screening and treatment. Cancers are going undiagnosed and untreated as the pandemic consumes health care resources, and as patients avoid hospital and clinic waiting rooms. In British Columbia, for example, it is estimated that up to 10 per cent of cancers are going undiagnosed due to the pandemic effect. Canada has recently passed a grim milestone of 20,000 deaths due to COVID-19. We know the pandemic will have a far broader toll for cancer patients beyond COVID-19. In fact, some experts are now predicting a “tsunami of cancer” in Canada in the coming years, as the system plays catchup with both diagnosis and treatment. But the pandemic has also forced change and efficiencies that could otherwise have taken decades to achieve. The same sense of urgency that delivered a COVID-19 vaccine within a year must be applied to cancer care, where it is imperative we embrace innovations like ctDNA testing. Cancer patients can’t afford to wait. If health systems demonstrate the flexibility to adapt, Canadian innovation is already providing the answers. Michael Ball is CEO of Vancouver based Canexia Health, and one of Canada’s applied genomics pioneers. The Hill Times