Could COVID-19 Winnow Out Low-Value Cancer Care?

Authors of JAMA Oncology opinion piece see priorities set in response to the pandemic as a chance to discourage low-value cancer care.

The COVID-19 pandemic has had all sorts of unintended consequences for American healthcare. Coming into 2020, no one thought we'd be leaping into a new era of telehealth and care delivered virtually.

The fact that utilization of routine medical services came to a screeching halt in March and April is creating an opportunity for another unintended consequence: winnowing out low-value care.

Former CMS Administrator Don Berwick, among others, have warned out rushing back to providing care without first considering whether some of the missed care was perhaps unnecessary (even harmful) in the first place.

In an opinion piece in today's JAMA Oncology, Bishal Gyawali, M.D., Ph.D., of Queen's University in Kingston, Ontario, Canada, and his co-authors, discuss the priorities that oncologists and cancer patients have made around the world because of COVID-19.

"The necessity to change, adapt,and innovate created by the COVID-19 pandemic may yield a more lasting series of changes that can helpe address overstretched, costly, and at times inefficient cancer care systemns," wrote Gyawali; Bishesh Sharma Poudyal, M.D., of the Civil Service Hospital in Kathmandu, Nepal, and Elizabeth A. Eisenhauer, M.D., of Queen's Hospital. "Decisions made during this period will be an opportunity to identify and discourage low-value practices in oncology."

In "real-life terms," they say, some oncologists stopped prescriptions of drugs with small clinical benefits but a high chance of an adverse event that would create hospitalizations. "Indiscriminate" off-label use of targeted therapies based on genomic alterations has slowed. "Even immunotherapy use has been reserved for cancers such as melanoma or lung cancer where the benefit is substantial," note the trio. They also reference a social media debate about whether women should get mammograms; in their view, most of their colleagues said no.

"We argue that we need to take it a step further — not just for mammography in particular but for every intervention or medicine — and consider if we should do it even if there is no pandemic," said Gyawali, Poudyal, and Eisenhauer.