COVID-19 Slows Research, But Trials Continue

To achieve optimal COVID care, cancer centers, academic medical centers, and community hospitals and clinics have transformed their operations, shuttering cafeterias and gift shops, prohibiting visitors, closing laboratories, and cancelling community events and conferences. Some are even making makeshift field hospitals in college dormitories, parking garages, and hotels. Some have moved their patients to other campuses to make room for those with COVID. Institutions have ramped up their telehealth efforts, holding virtual visits for routine check-ins. On Tuesday, for the first time in history here at Oregon Health & Science University, the number of virtual visits outnumbered ambulatory visits – 1,072 to 866. Virtual faculty meetings, rounds, and tumor boards are becoming commonplace.

In this new landscape, clinical trials are – for very good reasons – taking a backseat to clinical care. SWOG and the other NCTN groups are making major efforts to help reduce the burden on sites who continue to enroll patients to trials. On Monday, I sent a detailed memorandum to every SWOG Cancer Research Network member site to provide guidance about our trials. You can read it here on our COVID-19 clearinghouse. As you can see, we’re relaxing our data and specimen collection rules and rescheduling audits or going remote. We’re also creating a list of labs and biobanks that are open and able to process SWOG trial specimens, as well as creating a standard form for logging COVID testing of patients on SWOG trials. As soon as those documents are complete, we’ll post them to our clearinghouse.

Some may ask why we’re not shutting down all SWOG trials during this crisis. Our executive team overwhelmingly believes that, in some cases, trials remain the best – or only – treatment option for cancer patients. I think NCI leadership agrees. I think many of you agree. That’s why we’re keeping our trials open to accrual. While accrual has certainly been up and down over the last 10 days, probably more down on the population science side, some treatment trials continue to accrue at extraordinary rates. Needless to say, though, you must follow the lead of your institution. If you can’t enroll or safely enroll to clinical trials right now per your employer’s policy – don’t.

Based on an unscientific survey of 12 SWOG sites, Columbia University Herbert Irving Comprehensive Cancer Center in New York City – now the top hot spot for the virus – has shut down all trial enrollment. Vanderbilt-Ingram Cancer Center is also freezing trial enrollment, with the exception of accrual to COVID-related trials. But most sites report that they can put patients on treatment trials if there is immediate patient benefit.  At Yale, for example, most trial accrual has stopped, however patients can be enrolled in exceptional cases on trials with an oral therapy for a molecular target. M.D. Anderson Cancer Center, the Georgia NCORP, Huntsman Cancer Institute at the University of Utah, City of Hope, Lahey Health Cancer Institute, and the University of Michigan Rogel Cancer Center are allowing enrollment to treatment trials if physicians believe it’s the best way to provide patient care. For a broad look at clinical trials at this time, check out a host of news articles on our clearinghouse, including these stories from Nature, The Washington Post, and STAT.

When we surveyed SWOG sites, we also asked members to share messages for their SWOG colleagues at this time of crisis. Our people were so thoughtful, and so inspiring, I wanted to share some of their thoughts here:

“This is a time like never before. We need to do everything we can to help our patients on trial to get their therapy and support our teams to follow those patients and collect the data to the best of our abilities. All of our teams need to pull together and keep working on our science and planning for the future, so that when this hopefully ends we can restart better than ever.”

• Dr. Roy Herbst, Smilow Cancer Hospital at Yale New Haven

“The human spirit is resilient – we just have to block out the noise, make informed decisions, and look for inspiration wherever we can find it.”

• Dr. Dawn Hershman, Columbia University Herbert Irving Comprehensive Cancer Center

“Ultimately do what is best for your patients. If that means you can’t enroll (onto trials) because of safety or resources, then don’t enroll. There will be more opportunities in the future.”

• Dr. Brian Chapin, MD Anderson Cancer Center

“As we face the ongoing pandemic with COVID-19, our oncology community must embrace one of our most vulnerable populations, who are likely to get very sick from this virus: older patients with cancer. We should check in on our older patients, just as we would check in on our parents and grandparents. Consider virtual encounters to minimize their exposures.”

• Dr. Mina Sedrak, City of Hope

“We all need to remember that cancer does not stop for COVID, and our number one priority needs to be our patients who need expert care to deal with life threatening neoplastic diseases.”

• Dr. Jonathan Friedberg, James P. Wilmot Cancer Institute

“I think it is important for all of us to remember to take care of ourselves. In a time of great uncertainty, it is our responsibility to provide comfort and confidence for our patients, even when we ourselves may feel uncertain. This can be mentally and emotionally challenging. It is critical that we support each other in our lives, as oncologists and as fellow human beings.”

• Dr. Rajiv Agarwal, Vanderbilt-Ingram Cancer Center

“You are not alone. We are in this together.”

• Dr. Krishna Gunturu, Lahey Health Cancer Institute

None of us knows what the clinical trials enterprise will look like in three months. In fact, we don’t know what it will look like next week. And I am certainly not saying it’s “business as usual.” But, for the moment, sites that can are still running trials and treating patients with potentially life-prolonging or -saving therapies. And I hope we can continue to do so.