ABSTRACT
Introduction Early in the pandemic, Cancer Australia developed a conceptual framework which provided guidance on approaches to optimal cancer care in the face of significant health system challenges and risk of exposure to and harm from COVID-19. Emerging evidence during the pandemic indicated that cancer patients experienced considerable psychosocial impacts, including increased distress, depression and anxiety, and unmet information needs. Methods Evidence on the impact of the COVID-19 pandemic on cancer patients, cancer care across the care continuum, and health system capacity was reviewed, to June 2021. The conceptual framework was updated based on international and national published evidence, guidance, recommendations, and position statements. Results Supportive care strategies for cancer patients during a pandemic include extra vigilance by practitioners of screening for distress;improved communication with patients and their carers of changes to cancer care plans;provision of timely information and guidance to inform shared decision making;attention to the impact of infection control measures;, and adoption of innovative models of supportive care. Conclusions Cancer Australia's updated conceptual framework, underpinned by principles defining optimal cancer care, informs optimal supportive care across the continuum during a pandemic. It provides a planning resource for cancer care clinicians and policymakers for the current and future pandemics when supportive care needs are more paramount than ever.
ABSTRACT
Introduction To investigate immediate and longer-term impacts of the COVID-19 pandemic on cancer care in Australia and to provide context for consideration of system-level and oncology workforce challenges, we examined provision of a range of cancer services during 2020. Methods As a marker of cancer control activity, we examined sentinel diagnostic and therapeutic procedures relating to 14 cancer types using claims data for the Medicare Benefits Schedule, a listing of medical services subsidised by the Australian Government. Results Impacts of COVID-19 on cancer-related services were observed early in the pandemic with observed number of quarterly services notably lower than expected for most cancer types nationally. Some recovery of services through to March 2021 followed with modest increases in quarterly services above that expected for some cancer types. However, sustained impacts overall for 2020 were observed for many services with 8% (163,595) fewer diagnostic and 9% (14,600) fewer therapeutic procedures observed nationally in 2020 than were expected from historical data.1 Conclusions Recovery of service numbers may indicate workload increases for an already over-burdened oncology workforce and may contribute to physical and psychological fatigue in service providers.2 Potential implications of sustained impact on services include later stage at diagnosis, increased treatment complexity and poorer outcomes. Understanding of ongoing impacts on care delivery can inform cancer control planning beyond the pandemic.
ABSTRACT
Background: As the COVID-19 vaccine rollout commenced in Australia in early 2021, limited evidence was available internationally about the safety and efficacy of the COVID-19 vaccines for people with cancer, particularly because cancer patients were largely excluded from the initial clinical trials. As such, people with cancer had many questions about the COVID-19 vaccines. Australia’s Indigenous and culturally and linguistically diverse (CALD) populations experience poorer cancer outcomes and have specific information needs. As the national cancer control agency, Cancer Australia has a leadership role in providing information to support optimal outcomes for people with cancer, including Australia’s Indigenous and CALD populations. Methods: To understand and address the information needs about COVID-19 vaccines for people with cancer, Cancer Australia undertook a scoping review of national and international published literature and guidance, and sought input from key cancer control experts and consumers. In collaboration with Indigenous health and multicultural communications experts, Cancer Australia developed tailored information for Indigenous Australians and CALD populations affected by cancer. Results: Cancer Australia developed a range of information resources relating to the COVID-19 vaccines and cancer, including Frequently Asked Questions (FAQs), and multimedia promotional collateral including animation and radio advertisements. The FAQs were adapted to provide culturally appropriate messaging for Indigenous Australians with cancer and translated into the ten most spoken languages in Australia. Multi-channel social media communication promoted uptake of the resources to CALD and Indigenous communities, and between March and May 2021, the social media campaign received over 800,000 impressions and the FAQs approximately 20,000 page views. Conclusions: Throughout the pandemic, Cancer Australia has been responsive to the unique needs of the Australian cancer community. The development and dissemination of tailored information about COVID-19 vaccines for Indigenous and CALD populations is one example of how Cancer Australia aims to improve outcomes for all people with cancer in Australia. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
ABSTRACT
Background: Health professionals have reported significant reductions in cancer referrals during the COVID-19 pandemic. As national real-time cancer incidence data were not available, Cancer Australia designed an approach to analysing Medicare Benefits Schedule (MBS) data to provide evidence on the impact of the pandemic on cancerrelated services in Australia. Methods: Over 500 MBS items for diagnostic and treatment procedures for the five highest incidence cancers were identified and categorised into analysis groups based on cancer type and/or similarities in type of service. Data for January to December 2020 were examined at national and jurisdictional levels, and compared to 2019 to account for normal seasonal variation. Analysis of expanded data to March 2021 for additional cancer types, age, sex, remoteness and socioeconomic status, is being undertaken. Results: There were notable reductions in services across all diagnostic and surgical procedure groups. Initial reductions were observed between March and April for diagnostic procedures and between April and May for surgical procedures. Some services showed an initial recovery in May, and some showed partial or full recovery by June and further recovery by September. For some procedure groups, analyses showed sustained reductions over the 12 months to December 2020. Similar patterns of change were observed across all Australian states and territories, with some variation by jurisdiction. While the number of cases of COVID-19 were greater during Victoria's second wave of the pandemic (July-September), the impact on service numbers was less significant, likely owing to more refined policy approaches to managing health system and workforce capacity. Conclusion: Reductions in cancer-related services may impact patient outcomes, including recurrence and survival. Understanding Editorialmaterial and organization ©2021 John Wiley & Sons Australia. Copyright of individual abstracts remains with the authors. the nature and extent of this impact, including data disaggregated by population groups, will help to determine an approach moving forward to address any poorer cancer outcomes resulting from the pandemic.
ABSTRACT
Background: At the start of the COVID-19 pandemic, a plan for cancer management during a pandemic did not exist. It soon became clear that without proper planning, cancer outcomes would worsen. Cancer patients are at increased risk of COVID-19 infection, morbidity, and mortality. Health sectors internationally reduced or paused non-urgent cancer care to protect cancer patients from COVID-19. However, disproportionate delays in screening, diagnosis, and treatment can unduly impact cancer outcomes, and backlogs can further burden a strained health system. Tailored approaches to cancer management are required which balance health resource availability along with the risks of exposure and benefits of treatment. Australia's relatively low COVID-19 case numbers afforded Cancer Australia an opportunity to proactively plan for optimal cancer management during this, and future, pandemics. Methods: Cancer Australia's Cancer care in the time of COVID-19: A conceptual framework for the management of cancer during a pandemic (the framework) maps evidence-based cancer care considerations in relation to a health system's capacity across acute and recovery pandemic phases, in relation to steps of the cancer care pathway. The framework promotes infection control and resource prioritisation in the context of innovative care models, triaging approaches and individualised treatment plans, underpinned by effective communication and shared decision-making. Results: The framework supports health system planning and risk-stratified approaches to guide decision-making and improve cancer outcomes. Many aspects of cancer care are recommended to continue (to varying degrees) in most pandemic phases, with modifications or pauses in some aspects of care as the pandemic curve approaches or exceeds health system capacity. Principles of the framework were employed during the second wave of COVID-19 in the Australian state of Victoria, with continuation of cancer screening programs, diagnostic investigations, and treatments wherever it was safe to do so. This resulted in reductions in cancer services and treatment being relatively smaller than in the first wave. Conclusions: Cancer management in a pandemic is not a one-size-fits-all. Countries and jurisdictions need to tailor cancer care according to the risk of the health system becoming overwhelmed. The framework guides optimal cancer care to improve outcomes for people with cancer, while minimising COVID-19 infection. As further evidence becomes available from this pandemic or in future pandemics, this framework can be refined to inform ongoing and future pandemic health system planning.
ABSTRACT
Background: Given the impact of COVID-19 on Indigenous and ethnic minority populations observed globally, keeping COVID-19 out of vulnerable Aboriginal and Torres Strait Islander (Indigenous Australian) communities remains a priority. Compared to non-Indigenous Australians, Indigenous Australians experience disparities in cancer incidence and outcomes due to social disadvantage, increased cancer-related modifiable risk factors, poorer access to health services and lower participation in screening. During the pandemic, cancer-related investigations and treatment reduced significantly in Australia, leading to potential decreases in cancer diagnoses and consequences for future survival outcomes. Concerned about the risk of morbidity and mortality due to COVID-19 for Indigenous Australians, as well as worsening cancer outcomes, Cancer Australia undertook strategic health promotion initiatives, to inform and support optimal cancer care. Methods: In consultation with respected Indigenous colleagues to ensure cultural appropriateness of language and information, we published a dedicated webpage titled 'Cancer and COVID-19 - what it means for our Mob∗' with tailored information, advice, and links to key resources and support services for Indigenous Australians. We also released a video titled 'Act early for our Mob's Health', providing targeted, culturally appropriate, consumer-friendly information to encourage Indigenous Australians to see their doctor or Aboriginal Health Worker with symptoms that may be due to cancer. Results: The information hub has been well-received among the Indigenous Australian community, receiving over 3,200 visits, and the social media campaigns have received over 1.4 million impressions and 46,000 video views between mid-March 2020 to mid-February 2021. This campaign has supported proactivity among the Indigenous population in keeping their communities safe during the pandemic, maintaining a population rate of COVID-19 of less than one percent of all confirmed cases in Australia. Conclusions:Culturally appropriate information and resources developed through the process of co-design can help to influence positive health behaviour change in Indigenous populations. We predict that our strategic, multichannel health promotion campaign is contributing to keeping the Indigenous Australian community safe and informed during the pandemic, with additional work needed to monitor cancer rates and outcomes and address the ongoing information needs of the community. ∗Mob is a colloquial term to identify a group of Indigenous Australians associated with a family or community from a certain place.
ABSTRACT
Background: Australian oncologists reported dramatic decreases in cancer referrals during the pandemic. As real time data were difficult to acquire, Cancer Australia used surrogate measures to infer where reductions in medical services occurred. We analysed data available through the Medicare Benefits Schedule (MBS), a list of the medical services and professional attendances subsidised by the Australian Government, for the five highest incidence cancers: breast, colorectal, lung, prostate, and skin cancers. Methods: We identified over 500 MBS item codes for diagnostic and treatment procedures for malignancies and pre-cancerous conditions. Item codes were categorised into analysis groups based on cancer type and/or similarities in type of service. Data were examined at national and jurisdictional levels for 2020 to determine reductions during the initial COVID-19 period and to monitor subsequent recovery. Data were compared to 2019 to account for normal seasonal variation. Results: Australia's first wave of the pandemic ran from March to May, and a second wave in the state of Victoria alone ran from July to September 2020. We observed notable reductions across all diagnostic and surgical procedure groups examined, with initial reductions observed between March and April for diagnostic procedures, and a one-month delay for surgical procedures, between April and May. Some services showed an initial recovery in May, with many showing partial or full recovery by June. For some groups, analyses showed sustained reductions over the 12- month period. While COVID-19 case numbers were greater during the second wave, the impact on services was less pronounced, likely owing to more refined policy approaches to managing health system and workforce capacity. There was further recovery by September for some but not all services. Similar patterns of change were observed across all Australian states and territories, with some variation by jurisdiction. Conclusions: The pandemic has impacted the delivery of cancer care. Any potential delays in diagnoses and treatment due to these reductions in services may lead to more advanced cancer stage at diagnosis and poorer patient outcomes including recurrence and survival. Impact of COVID-19 on selected cancer services in Australia in 2020.
ABSTRACT
Background: Health systems pressures during the COVID-19 pandemic have driven adoption of innovative models of cancer care which optimise resources and protect patients and staff. High-value changes should be identified and retained to improve resilience of cancer care. Methods: Cancer Australia reviewed the literature and consulted with oncology health professionals, cancer control experts and consumers to examine elements of cancer care that changed during the pandemic. Strategies that support high-value care and improve cancer outcomes were identified. Results: The pandemic highlighted models of care which minimise risk of infection for cancer patients, whilst optimising outcomes. Of the numerous cancer care elements that we examined, this abstract focuses on key enhancements in digital health and treatment practices. Digital health helped maintain quality and continuity of cancer care during the pandemic. Use of telehealth (for clinical and supportive care), eprescribing, and e-ordering of investigations increased, supported by national health system funding. Shared care between care settings was facilitated by rapid uptake of telehealth, ehealth records, virtual multidisciplinary team meetings and secure messaging. Treatment modifications included hypofractionated radiotherapy, transitioning to oral chemotherapy where possible, and home-based palliative care. Lower thresholds adopted for use of G-CSF with chemotherapy to reduce risk of febrile neutropenia, aimed to decrease hospital admission rates. It is important to address barriers to uptake of these high value changes. For digital health, variations in patient access to telehealth and digital health literacy can be reduced through technical and coordination support (tailored to people with diverse needs and backgrounds), with telehealth consultations offered in safe, accessible clinical or community settings. Administrative and technical burdens in health service settings can be mitigated through sustainable IT infrastructure, standardised processes for appointments, and improving staff digital health capabilities. Patient anxiety regarding changes in care plans can be mitigated through transparent, accessible, and culturally appropriate communication, documentation and shared decision-making. Clinician uncertainty in calculating risks and benefits in treatment modifications can be addressed through evidence-based standardised care procedures and riskstratification protocols. Conclusions: Many modifications to cancer care made during the pandemic can have long-term benefits and should become standard care, including enhancements in digital health and treatment practices. Strategies have been identified which enable these changes and address barriers to uptake at the system-, service-, practitioner-, and patient-level. Efforts to embed high value changes are required across the cancer control sector.