Episode 15: Cancer testing during the pandemic

Voiceover:

Welcome to the NPS MedicineWise podcast, helping health professionals stay up to date with the latest news and evidence about medicines and medical tests.

Steve Morris:

Hi, I'm Steve Morris. CEO of NPS MedicineWise and welcome to another podcast. In our recent podcasts we've been looking at the impact of COVID-19 on chronic disease and in the last episode we talked about diabetes. Today I'm pleased to be speaking to Professor Dorothy Keefe, who's CEO of Cancer Australia. Hello, Dorothy.

Dorothy Keefe:

Hello, Steve. Thanks for inviting me.

Steve Morris:

Thanks for coming on.

Look, a couple of weeks ago, the Continuity of Care Collaboration, an organization made up of 30 peak medical bodies, industry groups and healthcare organizations released some data on the most common reasons that people have avoided seeing their doctor. The group looked at pathologist statistics and found that in April, diabetes testing rates fell by 54%, for example, from the month before the COVID-19 pandemic. But moving on to cancer issues, cervical cancer screening rates were down by 67% and for prostate cancer fell by 56%, and other cancer related tests dropped by as much as 60%.

So just interested on your thoughts on those statistics, Dorothy, and whether they match with the feedback that you're aware of.

Dorothy Keefe:

Yes. Thanks, Steve. So actually, last week we published an analysis of the Medicare benefit schedule data for cancer related tests, both diagnostic and therapeutic procedures from March to June. We looked at three big volume cancers, breast cancer, colorectal cancer, and skin cancers and we found that there was a significant drop in the therapeutic interventions and diagnostic tests for all of those three cancers in April, with some return in May and June, and a slightly different pattern with each. So they dropped between 20 and 55%. The skin and breast ones came up quite quickly, but colorectal cancer stayed down for longer.

So I think this all fits together with what you were saying, that there has been a reduction in diagnosis and treatment of cancer over the acute phase of the pandemic.

Steve Morris:

The consequences are likely to be, I suppose, fall in screening over the coming months and years, Dorothy.

Dorothy Keefe:

Well, Steve, I should clarify that we didn't look at screening. I believe that the AHW is going to publish some analysis of the actual screening rates from Australia in about a month's time. What we looked at was the MBS data. So it was the quickest way we could get hold of data that showed what had actually happened to be fair. And it showed that there had been a reduction in diagnostic tests outside of the screening programs and then treatments. So all of this together is showing that, not surprisingly, there has been a reduction in cancer diagnosis and therapy during the early phases of the pandemic.

But I think I should be clear and say that, that's probably acceptable in the short term because we did have a global pandemic and we did have to make very sure that the hospital system and the health system more generally could cope with the threatened waves of the pandemic, but we're now in a different phase and we have to be looking at what we do going forward to make sure that this doesn't continue.

Steve Morris:

Okay. So what you're saying in relative is that although some of the statistics are concerning, it really is, I suppose, in the light of the challenges that we've all been facing, it's not something that should have a long-term effect. So as long as we take action in the near future.

Dorothy Keefe:

That's exactly right. So what we're going to do next is we're going to look at the data from July and August, where we would expect to see a difference in Victoria because of their second wave compared with the other states. And we're also encouraging people to go to the doctor whenever they have any problems. So we've got a few little campaigns running. I don't know if you've come across them. We've got a Cancer Won't Wait campaign where we say to people, "If you have a symptom that worries you, and that could be associated with cancer, bleeding from somewhere, a new lump somewhere, go and get it seen to." And we've also just published an interactive body map on our website, canceraustralia.gov.au, where you can press on any bit of the body where you might have a symptom and see what symptoms in that area might be associated with cancer. So we're saying to people, "Have a look, check it out. Don't be afraid of going to the doctor. It's perfectly safe. Get yourself seen to."

Steve Morris:

And is that available now, Dorothy?

Dorothy Keefe:

Yes, it's on our website as we speak.

Steve Morris:

Do you just want to get the website again, just so people-

Dorothy Keefe:

Yeah, of course, Steve. It's canceraustralia.gov.au, and it also has a whole suite of resources about COVID-19, which I can talk to you about if you're interested.

Steve Morris:

Yeah. Please, please. Let us know about that.

Dorothy Keefe:

Okay. So what we did at the start of the pandemic is we looked at the things that Cancer Australia as the lead agency for cancer could do that would be useful and that other people wouldn't be doing. So the first thing we did was we opened a page where we curate all of the publications that are coming out around the world, in English, on cancer and COVID-19. So if you're a researcher or a clinician and you want to know what's been published, it's all there on that same website, canceraustralia.gov.au.

The second thing we did was look at the whole cancer journey and how you should treat cancer during a pandemic, depending on what phase of the pandemic you were in and what severity of the pandemic you're in. So if you were going to be on a curve like Europe or the U.S., you would need to be protecting your ICUs and protecting your health system and making sure that people weren't catching COVID-19 from going out. So you might have to make some changes to your system. Whereas if you were on a very flattened curve, you wouldn't have to make so many changes. And in the recovery phase, then what would you do as well.

So we looked at every stage from a screening and early diagnosis, right through to end of life care and said, "What would you do in this aspect of cancer treatment, depending on which curve you were on?" and that's quite a useful way to look at what we should be doing now and showing us that we should be treating cancer the same as normal now. We shouldn't be putting people off from having any tests or delaying treatments. We should be getting on with it, because you've got to balance as you know, the outcomes from your cancer and your outcomes from COVID-19.

The next piece of work that we've done apart from the data analysis is a recovery piece where we've got a whole group of experts from around the country to sit down and say, what are the things that have changed in cancer management over the last six months? And which of those should stay or go in the future? So they are things like telehealth. Telehealth is marvellous. Telehealth has enabled us to help people across the country, but 98% of telehealth is phone only. And that's not such a good thing. We probably need to increase the amount of video telehealth that's done. Again, hypo fractionation of radiotherapy, smaller number of doses of a higher fraction, just as effective. That would be wonderful for patients going forward to make sure they didn't have to come to the treatment centres so often. So there's a whole raft of different changes that have occurred that we need to analyze and think about.

Steve Morris:

Thanks for that overview, Dorothy. Just in terms of obviously other healthcare professionals, what advice would you be giving to them to, again, encourage patients to keep their appointments and go to see their doctor if they're concerned about anything?

Dorothy Keefe:

I think, Steve, I think it's really important that we all... It's a risk benefit analysis. You've got to look after the health of the population during the acute phases of the pandemic, absolutely. And you have to do the face mask, the hand washing, the social distancing, depending on how much community spread there is. But when you're in a phase like this, you've really got to be careful that you don't make some other conditions worse. And as you say, the chronic conditions like diabetes and cancer, mental health issues, they all need to be looked after.

So really what we're saying is, if you're not feeling right, if you've got a symptom that is new or progressing or unusual, you need to have it seen to. And I do know that sometimes it can be a bit off putting when you go online to make your GP appointment or you ring up and they give you a telephone appointment. And I think sometimes we need to have a little bit of permission to say, "No. I need a face-to-face appointment because I'm worried about something that needs examining." And that's the purpose of our Cancer Won't Wait campaign and our interactive body map, to give people a bit of a boost to their self confidence, to be able to say, "Yes, I want to do this." And of course the risk of catching COVID-19 in Australia is actually very low. And if we're all careful, it's perfectly safe to go to the doctor.

Steve Morris:

Yeah. Is there any final, last comments you might like to make, Dorothy, for our listeners?

Dorothy Keefe:

I think, we need to be careful that we all look after ourselves, our professional selves in this pandemic, because I'm afraid it's not going away very quickly. And we're entering into a more chronic phase where everyone's just a little bit more stressed because everything is just a little bit more difficult to do. And so I think it's really important that health professionals look after themselves so that they can look after their patients. I'm talking here about, not working 16 hours a day and not working weekends every weekend and actually taking holiday. I know, I sound like a mother really don't I? But it is about looking after yourself so that you can look after other people.

Steve Morris:

Yeah. And we repeated those messages in other podcasts. It's really important that health professionals look after themselves and each other as well as their patients.

Dorothy Keefe:

Exactly.

Steve Morris:

So thank you for your time, Dorothy, much appreciated.

Dorothy Keefe:

Always a pleasure, Steve.

Steve Morris:

And thank you, listeners.

Voiceover:

For more information about the safe and wise use of medicines visit the NPS MedicineWise website at nps.org.au.