COVID-19 may lead to 10,000 excess deaths due to breast, colorectal cancers
The COVID-19 pandemic will result in nearly 10,000 additional deaths due to breast cancer and colorectal cancer over the next decade, according to NCI projections.
This number — which represents a 1% increase in excess deaths due to these tumor types — is based on a “pretty conservative” modeling analysis, NCI Director Norman E. “Ned” Sharpless, MD, told American Association for Cancer Research Virtual Annual Meeting II participants.
“Our analysis assumes only a moderate disruption in screening and care that completely resolves after 6 months,” Sharpless said. “If the pandemic disrupts routine care to a greater degree or for a longer period, the effect on cancer mortality could be even worse.”
The model — developed by CISNET, a consortium of NCI-sponsored investigators who use simulation modeling to assess the effects of cancer prevention, screening and treatment interventions on incidence and mortality — highlights the potential impact of delayed diagnosis, deferred care, and use of reduced or nonstandard cancer care during the pandemic, Sharpless said.
“We did not consider cancers other than those of the breast and colon, but there is every reason to believe the pandemic will affect other types of cancer,” Sharpless said. “We did not account for additional cancer morbidity from upstaging, but this also could be significant.”
Removing funding disparities
Sharpless also spoke about NCI efforts to ensure workforce diversity and further its clinical research on disparities in health outcomes.
Two recent publications that address funding rates for Black and other minority scientists “paint a concerning picture,” Sharpless said, even after variables such as type of training, year of degree or research area are taken into account.
“NIH funding is key to the perception of academic success and ... it is the lifeblood of a large independent research enterprise,” Sharpless said. “If we don’t fix this, we will continue to miss out on the creative genius of underrepresented minority scientists, and our progress against cancer will be slower than it could have been and will be denied to many.”
To address this, the NCI has taken what Sharpless called a “pipeline approach” that seeks to identify and invest in talented, early-career, underrepresented minority scientists through funding, training and mentoring.
NCI’s Cure program provided such support to more than 4,700 trainees from 2001 through 2018. Much of this support is offered at the graduate school or post-doctoral levels; however, significant efforts have been made to identify potential recipients at the middle or high school levels. The support continues until participants’ first faculty appointment.
Evidence shows participation in the Cure program makes a difference, Sharpless said. Alumni of the program are significantly more likely than matched nonparticipating scientists to receive R01 funding as faculty.
“Participation in Cure appears to largely — if not entirely — remove the funding disparity for underrepresented minority scientists,” Sharpless said.
“Diversity makes us stronger because we need different ideas, different points of view and different approaches,” Sharpless added. “It makes science more equitable, and we owe it to our diverse patient population.”
Diversity in trial accrual
Sharpless also spoke about what he called the “vitally important” need to ensure accrual of underrepresented minority patients to clinical trials.
“We know there are important racial and ethnic differences to how patients respond to certain therapies,” Sharpless said. “Therefore, diversity in accrual assures that a study’s results are more generalizable.
“Perhaps even more important than that, we have come to understand that access to trials is a proxy for good care,” Sharpless added. “If underrepresented minority patients aren’t going on clinical trials, to me this is a sign that something is wrong within the engine of clinical cancer research.”
Accrual of minority patients to NCI-supported phase 1 to phase 3 trials has increased steadily since 1999, reaching approximately 27% by last year.
One strategy has been to place increased emphasis on minority- and underserved-designated sites in NCI’s National Clinical Trials Network and NCI Community Oncology Research Program trials.
“Not surprisingly, sites that do a good job of care for underrepresented minority patients also do a good job of putting their patients on clinical trials,” Sharpless said. “This has to be acknowledged as real and substantial progress against what has proved to be a very hard problem.
“But I think it is equally important that there is still progress yet to be made,” Sharpless added. “Data show we have been more successful increasing clinical trial participation among Hispanic patients than African Americans. I find that somewhat surprising, and we are working diligently to understand the explanation for this trend to see how we can improve it.”