Trends in new cancer treatments with targeted molecular therapies before and during the COVID-19 outbreak in Veneto, Italy: A real-world, population-based study.
Authors: Girardi Fabio , Tognazzo Sandro , Bortolami Alberto , Coppola Marina , Guarneri Valentina , Conte Pier Franco ,   on behalf of the Veneto Oncology Network (ROV)
Published: June 2021

e18734 Background: The COVID-19 outbreak has had a huge impact on health care services worldwide. Previous studies projected delays in cancer diagnoses and excess mortality for cancer patients as a result of the pandemic. Little is known, however, on the impact of the pandemic on the functioning of cancer services. We aimed to fill this gap by using a region-wide, population-based administrative health care data repository. Methods: We obtained data for patients initiating a targeted molecular therapy during 2017-2020 (January-September, by quarter) in Veneto. Eligible treatments were those with lapatinib, pertuzumab, TDM-1 and trastuzumab for breast cancer; with afatinib, alectinib, crizotinib, erlotinib, gefitinib and osimertinib for lung cancer; with cobimetinib, dabrafenib, trametinib and vemurafenib for melanoma; and with niraparib, olaparib and rucaparib for ovarian cancer. Patients starting more than one targeted molecular therapy in a given calendar year were included only once. We estimated the normalised difference between the number of patients for a given quarter in 2020 and the mean number of patients for the corresponding quarter during 2017-2019. Statistical significance was calculated assuming a type I error probability of 5%. Results: The study included 3,180 patients. In 2020, patients starting a targeted molecular therapy were 361 in the first quarter, 260 in the second quarter and 268 in the third quarter. The normalised difference between the number of treatments in 2020 and the mean number of treatments during 2017-2019 for all cancer types combined was statistically significant only for the first quarter, with more therapies in 2020 than in 2017-2019. In a breakdown by cancer type, differences were unremarkable for breast, lung or ovarian cancer, while there were significantly more treatments for melanoma for all the three quarters in 2020 compared to 2017-2019. Conclusions: We chose to use the rate of initiation of targeted molecular therapies as a proxy for the effectiveness of oncology services in managing cancer patients, because these therapies require that at least pathology and diagnostic facilities are fully operational. The study covered a population of nearly five million people, in a region where universal health coverage is available and where cancer care has been prioritised, by law, over non-cancer related health care services during the COVID-19 outbreak. Our findings suggest that provision of oncology care has not been substantially impacted by the pandemic in Veneto. Of note, label indications were unchanged for these drugs in 2020. The findings are also in line with the priority-based, adapted European Society for Medical Oncology recommendations. Further research is needed to assess whether delays at earlier stages of the route to cancer diagnosis (e.g. GP referrals for specialist care) may have occurred.