Transforming cancer care through earlier intervention
In our Q&A with Dave Fredrickson, we explore the efforts to continue innovating and bringing better care to cancer patients during and beyond the pandemic
1. Why is early detection and treatment so important to achieving better outcomes for cancer patients?
At AstraZeneca, we have the bold ambition to eliminate cancer as a cause of death. Early diagnosis is key in the quest for cure. If we detect cancer in earlier stages before it has spread, more treatment options are available which can increase the likelihood of achieving cure. Research and clinical data have shown the huge impact in outcomes for patients when targetable alterations are detected, allowing us to match them with precision medicines that best treat their type of cancer. The use of molecular testing for biomarkers to identify patients that could benefit from these targeted therapies has been a revolution for cancer treatment, and the recent introduction of gene sequencing technologies present even greater possibilities to treat patients with the best therapeutic options for their cancer.
Patient outcomes in early-stage cancers are significantly better than the prognosis when patients are diagnosed at a later stage. Take lung cancer for example: someone diagnosed with Stage IV lung cancer has a 15-19% chance of being alive at one year compared to 81-85% if diagnosed at Stage I. The picture is the same across a range of cancers: 5-year survival rates for both cervical cancer and colorectal cancer drop from around 90% when diagnosed early to around 15% when the cancer has spread. , Early detection is the goal, but unfortunately it isn’t always the reality: for example about two thirds of small cell lung cancer patients are currently diagnosed with extensive-stage disease, where the cancer has spread widely through the lung or to other parts of the body. For too many people, across tumour types, cancer goes undetected until it is in advanced stages – that’s why we need to maintain momentum behind screening and diagnosis and encourage people to see their doctors to assess possible symptoms of cancer.
2. What are the barriers to early diagnosis?
My career in oncology began 18 years ago and at that time, cancer outcomes weren’t what they are today. We’ve made incredible progress since then, however three key barriers to early diagnosis remain. Firstly, there is still a lot we don’t know about how cancers initiate and develop in the early stages. Better understanding of the science behind how cancers develop will help us to identify new tools to detect cancer early.
Secondly, in many cases the tools available today to detect cancer early are not being employed to their fullest extent. We need to ensure that scientific progress is rapidly translated into clinical practice. For example, we have clear evidence lung cancer screening in high-risk populations works, yet, widespread adoption around the world takes significant time, commitment and resources before we can fully realize the benefits.
Thirdly, cancer detection is a multi-stage process involving different teams and roles. The processes and pathways used to successfully detect cancer early and promptly refer patients for appropriate care are complex and require precise coordination and frequent evolution to ensure they are fit for purpose. Inefficient practices can lead to unnecessary delays, which can have a significant impact on the time it takes for a positive screening to lead to initiating treatment.
The COVID-19 pandemic has created an additional challenge, with fear of COVID-19 causing many patients to miss routine screenings and fail to act on suspicious symptoms. This is still urgent – every missed diagnosis is a missed opportunity to act early on cancer.
3. What are the key innovations in early-stage cancer diagnosis, treatment and care?
The future of cancer is one where patient experience can be transformed even before any treatment begins. We’ll be able to detect many types of cancer from a simple blood test, and diagnostic tests will predict who is at high risk of recurrence, allowing physicians to proactively tailor the ideal medical interventions and prevent progression before it happens. This future isn’t far away. Game-changing innovation is happening now across the whole cancer pathway – from screening through to treatment.
We already have revolutionary diagnostic tools at our disposal that are more convenient for patients, less invasive and with fewer side effects. These include low dose CT scans that can detect lung cancers too small for traditional X-rays, and blood-based screening which can detect more than 50 types of cancer and identify where in the body the cancer is located with high accuracy, all from a single blood draw.
There are also better screening and referral pathways in place for suspected cancers, such as robust protocols for investigating suspicious lung nodules found while treating or monitoring other health problems.
Once these cancers are detected, we can now test for several driver mutations and match a highly tailored precision medicine to the individual’s cancer. We can activate the body’s immune system to attack cancer cells, block tumour cells’ ability to reproduce, and deliver potent chemotherapy agents directly to cancer cells – not long ago, these treatment strategies were only theoretical. Now these strategies give us the chance to treat even the most deadly cancers.
4. As well as better outcomes for patients, what wider benefits are associated with early detection of cancer?
For both patients and healthcare systems, the case for early detection is clear. When we act early on cancer, patients have a better prognosis and better quality of life. In some cases, cancer is cured or can be treated and managed more like a chronic disease. Treating cancer earlier is also cost effective – treatment costs for early-diagnosed patients in high income countries are two to four times lower than treatment costs for those diagnosed with advanced-stage cancer.
Governments benefit from early detection of cancer too. Early diagnosis can help ensure people continue to live life to the fullest, play an active role in society, minimize the impact on their ability to work or their reliance on care from loved ones. The upshot is healthier, more productive populations. ,
As cancer progresses, survival rates unfortunately decline while costs rise, because patients spend more time in the hospital, undergo more rounds of treatment, and need additional supportive care which can include costly palliative care. When cancer is diagnosed early, it can be transformed from a fatal condition into a treatable one, which can help keep patients out of hospital – reducing care costs and contributing to overall health system sustainability. ,
5. The COVID-19 pandemic has had a massive impact on healthcare systems – how has it affected oncology healthcare systems specifically?
Before the pandemic, mortality from cancer had levelled off or in some cases decreased. The death rate from cancer declined by 29% from 1991 to 2017 in the US alone, including a 2.2% drop from 2016 to 2017, the largest single-year drop ever recorded. Rapid progress had been made to detect and act on cancer early and patient outcomes have improved as a result, but the urgent COVID-19 crisis has pushed cancer to the bottom of the agenda.
The impact has been felt across the world. The weekly number of newly diagnosed patients fell by nearly 50% across six cancers (breast, colorectal, lung, pancreatic, gastric and oesophageal). According to a survey by the American Association for Cancer Research, 79% of patients with cancer who were actively undergoing treatment had to delay some aspect of their care as a result of COVID-19, including 17% who reported delays to their cancer treatment.
The consequences of these delays could be monumental. The National Cancer Institute has warned that the drops in screening for breast and colorectal cancers alone may lead to up to 10,000 additional deaths in the next decade. One year could undo decades of progress, but this isn’t inevitable – and the cancer community is determined not to let it happen.
6. How can industry continue to work with the wider oncology community to mitigate the impact of COVID-19?
At AstraZeneca, we quickly joined forces with the cancer community to find new ways to keep driving forward progress – to ensure the hard-won ground gained against cancer in recent decades isn’t lost to the pandemic.
We kept clinical trials running with virtual visits and non-invasive data collection methods, improved access to testing and treatment by delivering more care at home and optimized treatment regimens to require less-frequent healthcare visits and reduce unnecessary exposure to the healthcare setting.
One example of this smarter way of working is the accelerated roll-out of our integrated oncology patient management platform HAYA, which brings together telemonitoring, telemedicine and delivery of remote care straight into patients’ homes. HAYA was developed with and for patients, healthcare professionals and care centres, originally piloted in France and now launching in eight other countries around Europe and in Canada with over 55 care centres enrolled.
We also partnered with governments and advocacy organisations and launched the New Normal Same Cancer campaign, urging patients and the broader public across the world to continue routine cancer screenings and to contact their doctors to investigate possible cancer symptoms which many have neglected during the pandemic.
We have also given our support, alongside over 300 other organisations, to a global initiative aimed at protecting cancer services from the immediate and long-term impact of COVID-19, led by the European Cancer Patient Coalition (ECPC) and the American Association of Community Cancer Centers. These groups outlined key policy recommendations to safeguard cancer services in a letter sent to EU Ministries of Health and policymakers and representatives of the World Health Organization (WHO). It’s testament to the power of collaboration that the WHO has requested a meeting with ECPC to discuss these recommendations.
When we started to see biomarker testing decline, we found a way to introduce a home testing service for EGFR and BRCA mutations. These critical tests enable patients to qualify for certain precision medicines best matched to their cancer. I’m proud to say that from March to September 2020, we reached almost 2,000 patients with home testing in Brazil, Mexico, Central America, the Caribbean and Argentina. That’s 2,000 vulnerable patients who could undergo testing at home rather than in the healthcare setting, and people who might not have otherwise had a biomarker test that could lead them to a precision medicine treatment option.
We’ve also been working to ensure timely access to screening by collaborating in new ways – including testing the concept of retrospective lung cancer screening in Russia, where hundreds of thousands of COVID-19 scans were analysed by the Moscow Radiology Department using artificial intelligence to determine if signs of lung cancer were present so patients could be referred for follow up.
These innovations helped keep people with cancer safe from the impact of the pandemic, and their benefits will endure. Many of these ideas piloted during crisis are leading to permanent changes that are making healthcare more technology-driven and patient-centric.
7. What does the future hold if we improve early diagnosis for patients with cancer?
We are closer than ever to transforming what a cancer diagnosis means – thanks to rapid progress across the whole cancer pathway in recent decades. We are deploying new strategies that transform the way people are diagnosed. We are revealing the genetic causes of cancer and matching treatments to patients who can benefit most from them. The unimaginable for cancer is becoming a reality.
However, cancer remains a global challenge. If we improve early diagnosis and intervention, this will be a huge leap forward. The evidence is clear that when we act early, we can improve survival rates and reduce suffering for many patients.
The COVID-19 pandemic has had a huge impact on cancer diagnosis and timely access to treatment. The cancer community united in response – determined not to let this slow the incredible progress that’s been made. We have seen innovation and collaboration on a global scale that will shape the trajectory of cancer care going forward. We will double down on our efforts to realise a future for cancer care with better patient outcomes, where early diagnosis is the norm.