To address the impact of the COVID-19 pandemic on oncology delivery systems and the management of patients, the Association for Value-Based Cancer Care (AVBCC) has held numerous webcasts as part of its series titled COVID-19 Impact on Cancer Care and Road to Recovery. Below are highlights from select webcasts in this series. The complete set of articles is available at www.TheOncologyPharmacist.com.
Impact of COVID-19 on Pharmaceutical Manufacturers
Pharmaceutical support and innovation are vital to the effective treatment of patients with cancer. In this discussion, moderated by AVBCC Founder and webcast series moderator, Burt Zweigenhaft, PhD, DLitt, a panel of experts addressed issues related to the changes being made by pharmaceutical manufacturers in response to the COVID-19 pandemic.
Mark Hagler, MBA, Senior Vice President and Business Unit Head, US Oncology, Sun Pharma, opened the discussion with a summary of the adaptations made in his organization. He said that his company has had only minimal product disruption because it has worked to increase stock with partners. Mr Hagler acknowledged that cash flow has become a problem for some of the customers, and they are extending payment terms where possible.
Roy Baynes, MD, PhD, Head, Global Clinical Development, and Chief Medical Officer, Merck Research Laboratories, discussed clinical research and late-stage production in the midst of the global pandemic and the effect of the crisis on cancer care and therapeutics. He said that his organization is continuing to work with an “eye to the worldwide effort to support investigative studies,” although the pandemic precludes many patients from participating in clinical trials. However, his colleagues are trying to maintain clinical study continuity and are striving to ensure that a clinical research trial is available wherever possible as a therapeutic option.
“We are open for business and strive to leave no patient behind,” said Dr Baynes.
Rena Goins, Executive Director, Global Trade, GPO, & Distribution, Regeneron Healthcare Solutions, also cited the emphasis on delivering therapy to patients, but noted that the location of delivery is fluid. “Paramount to all of this is the patient focus,” she said.
Ms Goins noted that 2 important modifications to policy have been the rapid acceptance of telemedicine by payers and allowing patients to have more than 30 days’ worth of medicine at a time.
Bryon Wornson, Vice President, Oncology Patient and Health Impact Lead, Pfizer, echoed remarks made by the other panelists. He said that his organization has also worked to safeguard the well-being of employees by going virtual. He noted that manufacturing and supply chains are not seeing any disruption in supply channels.
Mr Wornson also introduced the topic of a vaccine, which he said that Pfizer is “fast-tracking.”
“A vaccine will be central to returning to whatever the new normal looks like,” he said.
Bruce Wilson, Head, Access Strategy - US Oncology, AstraZeneca, said that his company is also working diligently on finding a vaccine and, importantly, it is also trying to understand how to supply a vaccine in the large quantities that will be necessary.
Impact of COVID-19 on Oncology Pharmacy
In an in-depth discussion, Niesha Griffith, RPh, MS, FASHP, CPO (interim), Columbus, OH, moderated a panel of experts from the oncology pharmacy sector, who shared their experiences and insights regarding the impact of the ongoing crisis on the delivery of care. Topics included how personal protective equipment (PPE) shortages have affected pharmacy providers, an overview of the current medication supply chain, and other COVID-19–related challenges.
Mike Ganio, PharmD, Senior Director, Pharmacy Practice and Quality, American Society of Hospital Pharmacists, discussed the way in which pharmacists use PPE. He explained that, in contrast to the use of PPE among healthcare providers, pharmacists do not use the equipment to protect themselves. Instead, they use it to maintain a sterile environment in the “clean room” where medications are prepared. Dr Ganio said that in addition to such things as sterile alcohol, which he noted has been difficult to obtain, there has also been a significant disruption in the availability of the widely used N95 respirator masks, which are important in oncology pharmacy practice.
Dr Ganio said that in his practice, he has seen shortages of intensive care unit drugs, ventilators, and sedatives and neuromuscular blockers used to sedate and paralyze patients before intubation. Although there has been some improvement, shortages are still critical, he noted.
Chris Marcum, Vice President, Enterprise Pharmacy, Cancer Treatment Centers of America, addressed the problem of medication stockpiling and hoarding. He also noted that there has been a problem with supplies of sedatives and antivirals, as well as maintenance medications such as inhalers and insulin. He suggested this can be attributed to shortages that ensued when payers changed the amount of medication covered under a plan from a 30-day supply to a 90-day supply in the wake of the coronavirus.
Bhavesh Shah, RPh, BCOP, Senior Director, Specialty and Hematology/Oncology Pharmacy, Boston Medical Center, MA, said that in the pandemic hot spot of Boston, MA, relief is beginning now, but during the peak of the virus, his facility alone saw a 600% increase in the use of sedatives and paralytics.
The panelists also spoke at length on the response of manufacturers to the economic crisis that many patients are facing. Because unemployment rates are high, pharmaceutical companies have broadened many patient assistance programs so that individuals can continue their medications.
“It’s been the quickest response we’ve seen,” said Ali McBride, PharmD, MS, BCOP, FASHP, FAzPA, Clinical Coordinator, Hematology/Oncology, The University of Arizona Cancer Center, Tucson.
Home infusion of oncology drugs has also become a hot topic, and the panelists offered their opinions on the feasibility of this option. They said that safety issues must be seriously considered, and it would only be an option for certain patients and drugs with appropriate supervision. Mr Shah acknowledged that it may be an option for patients meeting all the criteria, but it is “not for everybody.”
Stacey McCullough, PharmD, Senior Vice President, Pharmacy, Tennessee Oncology, said that home infusion has not been explored in her clinic because they have chosen to focus on safety and convenience for patients who go there for treatments.
Impact of COVID-19 on Telehealth
Telehealth has emerged as an essential component of healthcare during the COVID-19 crisis. In a wide-ranging discussion, a panel of experts, moderated by Rick Lee, Executive Chairman, Healthy Platforms and CancerLife, explored the current benefits and ongoing challenges of using this technology, as well as its potential impact on patients and practices in the years to come.
“It has taken this crisis to push us to a new frontier, but there is absolutely no going back,” said Mr Lee, as he referred to the speed with which patients and providers have embraced telemedicine. He provided a summary of the changes that have occurred since the beginning of the pandemic, including decisions by the Centers for Medicare & Medicaid Services (CMS) that have allowed expanded use of telehealth services. These changes have led to a significant increase in the number of telehealth visits that have occurred, contributing to the widespread acceptance of this modality.
Although telehealth is now widely accepted, there are certain complexities related to administration and practice that must be managed for continued success.
“Having regulatory experience is imperative, in particular during this time when things are very fast-moving and fast-paced and we are seeing changes in CMS rules and regulations almost biweekly,” said Chevon Rariy, MD, Director, Telehealth, Cancer Treatment Centers of America. In particular, “medical records maintenance is key” when deploying a telehealth program that is embedded within a larger healthcare system, she noted.
Brian Leyland-Jones, MD, Chief Medical Officer, National Foundation for Cancer Research, pointed out that in the delivery of specialized healthcare in a rural environment, where patients were required to travel up to 500 miles to a clinic, systems were already in place and functioning well. “We have all adjusted so rapidly,” he said.
During the discussion, the experts also considered the ways in which telehealth services can be used to address patient needs beyond the immediate impact of the coronavirus. For example, the use of these services for patients with illnesses other than cancer is a potential area of expansion. It is already being used in some programs to mitigate loneliness among patients whose illness or geography results in social distancing that is not solely pandemic-related. “Loneliness is disease agnostic,” Karen Keown, RN, Co-Founder, Vida Healthcare, said, referring to these patients.
The panelists also explored how telemedicine could potentially affect clinical trials and other multidisciplinary applications. “There is a concern that they cannot get enough patients into clinical trials and it is hurting research. And then there is the retention aspect,” said Bob Gold, Chief Behavioral Technologist and CEO, GoMo Health. Rethinking protocols could have a positive impact on areas of research going forward, he added.
Although proposed expansions in telemedicine show promise, they are not without drawbacks. One crucial factor is the extent to which payers would be open to covering these services.
Burt Zweigenhaft, PhD, DLitt, acknowledged that it may be more complex in a post–COVID-19 environment. “I am hoping that the combination of government, private enterprise, and providers will be the solution,” he said.