Learning lessons from across Europe – the hidden costs of COVID-19 on lung cancer

Since early 2020, health systems around the globe have marshalled a response to the nearly unrelenting demands of the COVID-19 pandemic. Other diseases and health needs have not stopped, but patients’ access to services for these has been paused or delayed, likely leading to further loss of life among people with conditions like cancer, where time to treatment is critical.

Diagnosis of all cancers has been affected by the COVID-19 pandemic. Action on lung cancer warrants particular focus. Lung cancer is the largest cause of cancer deaths across the world, and globally there are over 1 million deaths from lung cancer every year.

The challenges in early diagnosis and treatment of lung cancer are now exacerbated by the overlap between symptoms of COVID-19 and lung cancer, and the need for respiratory physicians in the care of patients with either condition. It is important to learn lessons from the impact of the pandemic on health systems and care delivery now, so we may work to rapidly resolve disrupted care pathways and secure improvements to lung cancer services and patients’ outcomes in the long term.

To that end, the World Economic Forum, in partnership with the Lung Ambition Alliance, established a taskforce to learn from the impact of COVID-19 on lung cancer services. A series of meetings brought together clinicians, patient representatives, policy makers and industry partners from five European countries (France, Germany, Italy, Spain and the UK) to identify lessons that could support the short- and long-term resilience of lung cancer services. Captured below are several of the taskforce’s findings and recommendations for diagnosis, lung cancer care and clinical trial participation.

The main reason why the five-year survival rate in lung cancer is still poor is because the vast majority of clinically detected lung cancer cases are diagnosed at an advanced stage, when treatment options are limited.

Prognosis for lung cancer is highly dependent on the stage at which it is diagnosed: a person diagnosed with stage IV lung cancer has a 15% chance of surviving one year – compared to 80% if detected at stage I. Spotting lung cancer early relies on several things – patients noticing symptoms or understanding their own risk and presenting to health services accordingly, primary care physicians recognising patients at risk of lung cancer and referring them quickly, and easy access to diagnostic services. All of these have been affected by the pandemic – for example information from the UK shows up to a 75% drop in referrals to a lung cancer specialist in some areas during the first wave of COVID-19.

Looking at the response to the early stages of the pandemic, it is possible to identify key lessons and bring actions forward to address delays in diagnosing lung cancer.

Even after lung cancer patients have been diagnosed, the COVID-19 pandemic has an impact on the services that they have been able to access. An IQVIA survey of 528 oncology specialists from across the EU5, identified lung cancer as the third most impacted area of oncology across Europe, due to delays to diagnosis from the pandemic. Patient transfer delays, reduction in access to diagnostic equipment and other system pressures are resulting in a decrease in achieving a diagnosis within critical time.

The COVID-19 pandemic has had a considerable impact on lung cancer services. In an effort to sustain patients’ access to services, innovative approaches to service organisation and delivery have been employed – particularly during the early stages of the pandemic. This included widespread use of telemedicine, greater use of virtual meetings and remote monitoring of patients. In Russia, for example, AI is being used to retrospectively review CT scans conducted for COVID-19 diagnosis. This analysis has led to the detection of incidental lung nodules indicative of lung cancer that had not previously been diagnosed.

Through the use of data and technology, there have been examples of countries uniting to champion information in the fight to overcome COVID-19. The global TERAVOLT consortium was established in 2020, as a physician-led syndicate that examines the impact COVID-19 has on patients with thoracic malignancies.

As we continue to live with COVID-19, we need to see investment in technology to support patients throughout their lung cancer journey.

All medicines must undergo rigorous testing prior to being licensed, including through clinical trials. This is especially important for conditions such as lung cancer, where patients’ outcomes remain poor and access to innovative medicines can be critical to improving survival and quality of life.

The COVID-19 pandemic has had an impact on clinical trials for lung cancer, with only 14% of sites in Europe continuing to enrol patients at the same level as prior to the pandemic. On the other hand, we have also seen innovations in the way trials are conducted and reviewed, such as greater use of real-world evidence, remote monitoring and rolling reviews, which should be evaluated for continued use as we enter a post-COVID-19 world.

The impact of the pandemic has been wide-reaching – and will continue to be so – and it is critical that we do not lose sight of the people who are at risk of becoming hidden victims of COVID-19. The past few years have seen considerable advances in treatment options for lung cancer, yet prognosis remains poor. We now have the opportunity to learn lessons to change this.

The findings from the taskforce should assist governments, health systems, healthcare professionals and others to come together to understand the effect of the pandemic on lung cancer care, to address the immediate impact on lung cancer services, and to ensure the resilience of the system in the longer term for the benefit of lung cancer patients.