Changes in systemic cancer therapy in Australia during the COVID-19 pandemic: a population-based study

Abstract

Background Since the emergence of COVID-19 there have been increasing global concerns about delays and/or discontinuations in cancer care. However, it is unclear to what extent systemic cancer therapy was impacted by COVID-19 in countries with relatively low COVID-19 infection rates. We examined changes in systemic cancer therapy in Australia during the COVID-19 pandemic. Methods We conducted a national observational study using de-identified records of government-subsidised cancer medicines dispensed to a random 10% sample of Australians between January 2017 to December 2020. We reported monthly dispensing and initiation rates of antineoplastic (chemo-, immuno- and targeted therapy), endocrine and supportive medicines per 100,000 population. We reported monthly discontinuation rates (defined as ≥90 days gap between cancer medicine dispensings) per 1,000 people treated. We used interrupted time series analysis to examine changes during times of increased COVID-19 risk and related public health measures (March, April and July 2020). Findings Between January 2017 and December 2020, 1,011,255 cancer medicines were dispensed to 51,515 people. Overall, there were no reductions in antineoplastic dispensing or initiation during the COVID-19 pandemic. In March 2020, we observed a temporary increase of 39/100,000 (95% CI: 14 to 65/100,000) in antineoplastic dispensing, driven by immunotherapy and targeted therapy. In April 2020, we observed a temporary decrease in chemotherapy initiation (-2/100,000, 95% CI: -4 to -1/100,000) and temporary increase in discontinuation of all antineoplastic medicines (35/1,000, 95% CI: 20 to 51/1,000), but these changes were not sustained. Interpretation The effective control of COVID-19 in Australia appears to have mitigated the initial impact of COVID-19 on systemic cancer therapy. We observed only small and temporary changes in the use of some cancer medicines early in the pandemic. Funding National Health and Medical Research Council; National Breast Cancer Foundation; Translational Cancer Research Network, supported by the Cancer Institute NSW.

Impact of COVID-19 in Cervical and Breast Cancer Screening and Systemic Treatment in São Paulo, Brazil: An Interrupted Time Series Analysis

“…42 A similar finding was also described in Australia. 43 Similar to our findings in cervical palliative setting, Blay et al, 44 in their analysis of French data, reported an increase in the number of patients who initiated palliative treatment. In their analysis of the quantity of treatment and scheme of treatment changes, Eijkelboom et al 45 reported that chemotherapy was less likely to be performed against hormonal therapy for breast cancer treatment.…”

Comparison of Use of Neoadjuvant Systemic Treatment for Breast Cancer and Short-term Outcomes Before vs During the COVID-19 Era in Ontario, Canada

“…16 In Australia, where there was a low burden of COVID-19 at the time, any changes in the dispensation of chemotherapy was small and transitory, driven by immunotherapies and targeted therapies. 17 In contrast, the number of registrations for neoadjuvant-intent ST decreased in England and Italy due to COVID-19. 18,19 In the United Kingdom, following multidisciplinary consultation many patients with breast cancer had incomplete neoadjuvant chemotherapy or instead received adjuvant chemotherapy.…”

Changes in dispensing of medicines proposed for re-purposing in the first year of the COVID-19 pandemic in Australia

“…Stockpiling has been observed internationally as well [ 21 , 22 ]. While to our knowledge there have been no reports of people with legitimate needs for these medicines being unable to access them [ 23 ], nor increases in adverse events, stockpiling does put pressure on medicine supply and may exacerbate shortages. This is particularly true during crises such as the COVID-19 pandemic which led to disruptions of the global supply chain through lockdowns, understaffing, and travel bans [ 24 ].…”