COVID-19 and pandemic preparedness

Cancer care during a pandemic such as COVID-19, requires a careful balance between the risk of exposure to, and harm from, the pandemic infection and the potential adverse impacts from disruption to cancer care.

Pandemic preparedness involves planning to strengthen prevention and surveillance, to protect the health and safety of individuals and communities from the pandemic infection, and to consider capacity of the health system and available resources to deliver care beyond the pandemic infection, including cancer care.[89]

Equity of access during a pandemic

People with cancer may be at increased risk from a pandemic infection because of factors including age; comorbidities such as cardiovascular disease, diabetes, and chronic lung disease; immunosuppression; and high levels of interaction with health care providers. Prioritising and giving rapid access to care for people at high risk of harm from pandemic infection, including people with cancer, older people, and Aboriginal and Torres Strait Islander people, can support equitable outcomes and experiences during a pandemic.

Impact of a pandemic on cancer care

Pandemics can significantly impact care for cancer patients across the cancer care continuum (from prevention and early detection to treatment, survivorship and end-of-life care). As health system capacity varies during the different stages and scenarios of a pandemic, so do the resources available for cancer care delivery.[90] The increased demand on the healthcare system related to a pandemic can decrease the availability of resources for non-pandemic healthcare, including for cancer patients. These resources include skilled health care staff; pathology and imaging services; and hospital beds and medical supplies including personal protective equipment and consumables.[91][92]

Suspension of cancer screening services to limit the spread of a pandemic infection, or hesitancy to seek health care due to risk of infection, can result in patients presenting with more advanced disease, which may require more complex treatments including systemic therapies and poorer cancer outcomes.[93]

Workforce shortages can result from a variety of factors, such as staff with pandemic infection including through healthcare-associated outbreaks; staff in quarantine or isolation because of exposure; redeployment of staff (including oncology staff) to meet the demands of the pandemic, reducing staff available for cancer care; and travel restrictions and lockdowns. Additionally, a pandemic can negatively impact the mental health and wellbeing of the health workforce by causing distress, burnout, and fatigue.[94]

Evidence and recommendations for cancer care

Some new or modified health care practices adopted during the COVID-19 pandemic will be of long-term value in improving the quality and resilience of cancer care in Australia.[94] This includes:

• strengthened collaboration within the oncology sector, including sharing of data and information, and timely publication
• increased use of technology across the cancer care continuum, including in providing responsive supportive and palliative care, telehealth and teletrials, and virtual multidisciplinary team meetings
• improved health system organisation and innovative care models that minimise overloading of acute care facilities
• greater aspects of cancer care delivered by a general practitioner, which supports continuity of follow-up care, increases the capacity of specialists and hospitals to focus on patients requiring urgent care, and enables engagement between patients and health professionals in diverse locations
• tailored engagement with priority population groups and co-designed, community-led collaborative endeavours for improved individual and community understanding, adherence and equitable experiences and outcomes.[88]

Evidence from the COVID-19 pandemic supports the continuation of cancer care wherever possible during a pandemic to minimise the adverse impacts of the pandemic on cancer care.[90] Cancer Australia’s Conceptual Framework for Cancer Care During a Pandemic: Incorporating Evidence from the COVID-19 Pandemic[90] provides guidance on continuation of care across the cancer pathway, in the face of challenges to health systems, while minimising infection risk for patients with cancer and unintended consequences of delays in screening, diagnosis, and cancer treatment and backlogs because of service interruption.

Australian Cancer Plan activities to support pandemic preparedness

• Strengthened public health partnerships can be leveraged to promote and disseminate cancer prevention, surveillance, and broader health strategies in response to a pandemic, and support mental wellbeing
• Improved access to population screening and activities to encourage risk recognition and symptom awareness can improve early detection of cancers and help address unintended consequences of delays in screening and diagnosis during a pandemic
• Evidence-based, risk-stratified population screening can assist in the prioritisation of available services for population subgroups most likely to benefit
• Integrated navigation models that incorporate virtual health, telehealth, and multidisciplinary care can promote viability in a pandemic setting
• Health literacy programs and tools can be leveraged in a pandemic setting to rapidly disseminate information about changes in recommendations to cancer care, or alleviate concerns and quell potentially harmful misconceptions
• A Health Equity in Outcomes Framework focusing on stakeholder engagement, tailoring measures to priority populations, considering the determinants of health, and integrating the consumer experience can help to avoid disparate outcomes being exacerbated in a pandemic setting
• An Australian Comprehensive Cancer Network can enhance national coordination and planning of cancer services during a pandemic
• Evidence-based, innovative models of integrated multidisciplinary care incorporating strengthened digital health and primary and community care, can shift care away from the tertiary setting where appropriate, contributing to the safe continuation of care during a pandemic
• An agreed minimum cancer dataset that can be expanded upon as required can support rapid and consistent collection of metrics necessary for a well-informed public health response
• Innovative approaches to redirect funding to areas of unmet need can accelerate research investment to address the emerging needs in a pandemic setting
• Workforce capacity and capability planning to support a well-equipped workforce prepared for escalation, and to define safe scope of practice roles to meet pandemic requirements
• Strengthened partnerships and collaborations with communities and Aboriginal and Torres Strait Islander-led organisations can be leveraged during a pandemic to enable the pandemic response to be community-driven and culturally safe.

Key frameworks, strategies and plans relevant to pandemic preparedness