For cancer patients, personalised care matters more than ever

Time can be a matter of life and death for cancer patients. Early detection and treatment are essential to improve outcomes, and consistent care is crucial. But the pandemic puts cancer patients at increased risk in three ways:

• A trip to the nearest hospital can be more than a day of arduous travel for patients in rural regions, even in normal times. In the early months of the pandemic, access to healthcare changed for nearly everyone, and infrastructures – from transit to healthcare – broke down.

• Lockdowns and overburdened hospitals prevent patients from seeking testing or treatment. Some are simply too scared to go, even if they could.

• For cancer patients – who are immunocompromised – the risk of infection from COVID-19 and other diseases is particularly high, especially in overcrowded spaces.

Since the pandemic, government and academic institutions report massive declines in cancer care globally. Oneshows that nearly 61% of oncology centres across 18 countries reported reduced clinical activity during the first peak of the pandemic, and nearly two-thirds cited under-treatment as a major concern.

Data presented at the ESMO Virtual Congress 2020, in that same study, shows that treatments most likely to be cancelled or delayed at cancer centres were surgery at 44%, chemotherapy at nearly 26% and radiotherapy at nearly 14%. Palliative (quality of life) care ended earlier in 32% of centres.

Regular screenings plummeted, too, reducing the odds of early detection, which translates to decreased survival odds for those diagnosed at a later stage.

Othersuggest a roughly 80% drop in March and April 2020 in the U.S. alone, in routine screening appointments that could catch new cancers. Anotherestimated that screening for breast, colon and cervical cancer in the U.S. dropped by about 60% from mid-March to mid-June 2020.

Roche affiliates around the world recognised early that cancer patients were among those being left behind in the race to combat the pandemic. And they were determined to find new and innovative ways to help.

“The situation in Italy was difficult; it was one of the most hard-hit countries,” says Luca Lattanzi, Brand Manager of Precision Medicine at Roche.

In some ways, it was the perfect storm for the pandemic: The risk of cancer increases with age, and almost a quarter (23.1%) of Italy’s population is estimated to be 65 years and older – the largest percentage of elderly in Europe in 2019. Research shows that coronavirus is more of a threat to older people, who, if they get the disease, are more likely to have a severe case.

“We learned from our own field force and physicians that cancer patients in Italy were not always able to go to hospitals to undergo testing or treatments,” Luca says. “The first lockdown was the spark that pushed us to think outside the box and come up with a way to help.”

One of the solutions? A liquid biopsy in the form of a simple blood draw, performed directly in the patient’s home by a traveling nurse. The nurse arrives at a specified time, draws two vials of blood and packages them for courier pickup within four hours. The vials are sent to a special lab, which can test a tumour for genomic alterations, giving the doctor and patient greater insight to target treatment options.

1. Healthcare provider orders the liquid biopsy test; sends privacy consent forms to patient

2. Patient signs forms by email or video/audio recording

3. Patient information is uploaded to a secure system

4. Nurse arrives at patient home with kit and pre-printed patient form

5. Nurse performs blood draw, fills the box and seals it, and leaves with any biowaste

6. The blood sample is refrigerated by the patient and collected by courier within 4 hours.

Every person has a unique set of genetic instructions, called a genome. Cancer is a disease of the genome, caused by genomic alterations that make a tumour grow. Comprehensive genomic profiling, or CGP, is a powerful tool for proper diagnosis and treatment planning. It tests a tumour’s DNA for more than 300 genomic alterations, and offers a summary of treatment options based on the alterations identified. This gives the doctor and patient options for care that are tailored to the individual causes of the disease.

Comprehensive genomic profiling can be performed through a tissue biopsy, where a tissue sample is taken from the body, which is invasive and must be done in a hospital or clinic. Liquid biopsies (blood draws) give people with cancer a minimally invasive way to identify a targeted cancer therapy. For example, lung cancer patients whose disease has progressed may have less tissue available for biopsy, or the tumour may be in a hard-to-reach location.

“There’s also the mental side of it,” says says Paulo Neto, Customer Experience Lead for Personalised Healthcare and Foundation Medicine, part of the Roche Group. “People are more comfortable and confident in their homes. So the blood draw is in their own space, their place of shelter. That emotional part is very important; we are coming to them on their terms. We are talking about cancer patients, and many of them are already fragile in their condition.”

In just two months, under lockdown conditions and in the midst of pandemic mayhem, the Roche Italy team launched a safe, secure and patient-focused mobile blood draw program that brought liquid biopsy testing to cancer patients in need.

“Everyone involved in the project was aware of the value of this project and the urgency to bring a solution to our patients,” Luca says. “Some of the most vulnerable in society were in need, and speed was essential. But patient privacy and safety were equally important; it was absolutely key for this project. And we were lucky, because we relied on a trusted partner, a national network of specialised nurses, that had already collaborated with us in Italy.

Similar programs launched at Roche affiliates around the globe. In Canada and Spain, hospitals were overburdened with COVID-19 patients and in-patient visits were limited to immediate, urgent need. The affiliates partnered with local infusion clinics to ensure patients could make appointments across a network of nationwide clinics and receive liquid biopsies in a safe, convenient environment.

Patients book the test online, and receive peace of mind knowing that the quick, minimally invasive test will minimize their risk of infection and give them, and their oncologist, insights to pursue personalised treatment decisions based on their disease progression.

“For patients, it's all about time with cancer,” Paulo says. “Time is really critical for them. And many patients who undergo genomic testing, unfortunately, are in the late stages of disease. So they are looking at this test with the hope that it might open different possibilities. In this phase of their disease journey, time matters more than anything.”

Liquid biopsy programs have been in place in some countries for a few years already, serving patients who cannot easily reach a hospital or clinic. The solution, now tested under the pressure of a pandemic, will give patients more and better options in the future – and on their terms, says Mauro Brovelli, Precision Medicine Customer Service Team Coordinator.

“I am absolutely convinced this solution can be just as practical in the following years, beyond the pandemic,” Mauro says. “The model in Italy works well; it works well in other places, and we will continue moving it forward. This helps our patients to be safe and to find answers more quickly. It gives us new ways to serve them, and puts the focus on the patient. In the end, that’s our focus, too.

In India, the majority of the population lives far from major hospitals; most seek treatment at tertiary care centres in outlying areas. Roche launched a mobile blood draw program in 2017 to better serve that population.

But COVID-19 brought new challenges in keeping the program running to serve patients. In the early days of the lockdown, there was a lot of uncertainty about COVID-19; tests that required genetic material to be sent outside of the country were deemed “non-essential” by the government, while allowing only “essential” items to be shipped. Test kits – which contained vials of blood destined for genomic testing at a lab – did not clear customs and instead sat idle.

“It came as a shock; the entire program came to a standstill,” says Nippun Sandhir, Therapy Area Medical Expert-PHC in Mumbai. “But with timely interventions, the team was able to get necessary documentation that allowed test kits out of India and on the way to the laboratory in the U.S. in 15 to 20 days. Those were days of extreme uncertainty, for us, and we knew there was no option but to find a solution. Patients depend on it.”

In Brazil, where there are vast differences in access to healthcare, a mobile blood draw program was launched several years ago. About 80% of all liquid biopsy tests in the country are conducted through the mobile blood draw program.

“For some years now, we have the possibility to have home care assistance collect the liquid biopsy,” says Viviane Pinto, Customer Services and Operations Coordinator for Foundation Medicine in São Paulo. “It is an alternative we offer to our patients, and they have the right to choose to either go to a laboratory facility or have a home care nurse complete the procedure. It is a service offered without any additional cost, and even though it is already available for some time, it was specially used during the pandemic in 2020.”