COVID, Roe v Wade decision threaten cancer progress, scientists say

The great strides in cancer survivability seen in recent decades could be undercut by fallout from the pandemic, the overturning of Roe v. Wade, and continued disparities in health care access, scientists warn.

The good news: There’s been a 32% reduction in American cancer deaths from 1991 to 2019, with a 2.3% drop every year between 2016 and 2019, according to the American Association for Cancer Research.

• Plus, the FDA approved eight new “groundbreaking” anticancer therapeutics in one year, the AACR said in its 2022 cancer progress report.
• These include a new front-line treatment for advanced melanoma (Opdualag), the first drug (Kimmtrak) to treat the most common form of adult eye cancer called uveal melanoma, and the first molecularly targeted treatment (Welireg) for cancer patients with Von Hippel-Lindau syndrome, a rare genetic disorder that causes a massive growth of tumors and cysts.
• In that same period from Aug. 1, 2021, to July 31, 2022, the FDA also approved two new diagnostic imaging agents (Locametz and Cytalux) and expanded the use of 10 other cancer drugs.
• “They’re really busy over there — they are approving drugs at a rate that we’ve never seen before,” Anna Barker, chief strategy officer at Ellison Institute, said at the AACR press briefing. “This whole movement has changed the world.”

The bad news: This progress could be offset by threats from multiple fronts, the researchers said.

1) The pandemic caused a “very significant decline” in early detection, screening, and overall attention to patient health, AACR president Lisa M. Coussens said at the briefing.

• They predict “there will be an increased incidence of late-stage cancer that will start showing up this year and next year,” she said.

2) Continued disparities in health care access, combined with underrepresentation of some racial and ethnic groups in clinical trial participation and in the health care workforce, contribute to a higher risk of cancer incidence and death faced by many underrepresented groups, John Carpten, chair of the National Cancer Advisory Board, told the press briefing.

• For instance, gastric cancer is nearly twice as likely to be found in American Indian/Alaska Native, Asian, Hispanic, and Black people compared to non-Hispanic white individuals, per the report.
• Lung cancer death rates are 34% higher among residents of rural areas compared to those in cities.
• Georgia Rep. Nikema Williams said, via a video: “We have two health care systems in this country: one for people who can afford preventative services and quality treatment, and one for everyone else. We must demand better. Black Americans have the highest death rate and shortest survival of any racial and ethnic group for most cancers.”
• And, the pandemic made those cancer disparities worse.

3) The reversal of Roe v. Wade has led to 17 states so far restricting or banning abortion, which can have ramifications on other medical issues. Adam P. Dicker, a member of the report’s steering committee, told Axios that it’s surprisingly common for women to experience cancer concurrent with pregnancy — roughly one in every 2,000.

• Chemotherapy, radiation therapy, and targeted therapies sometimes include a high risk of fetal malformation or spontaneous abortion, and “uncertainty may prohibit some physicians from prescribing a drug or performing other health services in a timely manner due to the potential legal consequences,” the report warns.

• “So, the impact of the [state bans] is to prioritize the fetus over the mother, and that can compromise her life” if a cancer remains untreated for months, Coussens tells Axios.
• An added consequence, she said, is that some pharmacists won’t prescribe cancer drug treatments that also could be potentially used to induce an abortion. One is methotrexate, which is a key standard-of-care drug for certain autoimmune disorders and cancers that’s been reported as hard to obtain.
• “A consequence of overturning Roe is that drugs like methotrexate are now coming under scrutiny and being denied to women of childbearing age for fear they might utilize the medication to induce a spontaneous miscarriage,” Coussens said.
• Dicker said this reduces patient autonomy and also places oncologists at risk of civil or criminal charges.

Meanwhile, the AACR outlines in its report its policy recommendations “to ensure that the U.S. maintains its momentum against cancer for all patients.”

The bottom line: “One thing we learned [from the pandemic] is that if we really want to do something, we can. We think about Operation Warp Speed and the convergence of industry, the government and the community to say this is something we have to address and we have to address now,” Carpten said.

• “We’re hoping we’ll see similar efforts and initiatives moving forward in cancer.”