The Time To Act campaign, which aims to tackle the stalling of cancer treatment during the pandemic, was launched in May. Professor Antonino Spinelli, ESCP General Secretary, took part in the campaign event and is interviewed here by Nagendra Dudi-Venkata and Yongbo An from ESCP's SoMe Subcommittee.
Background
On 11 May 2021, the 'Time To Act campaign: Don’t let Covid-19 stop you from tackling Cancer', was launched by a group of European political leaders in cancer, including EU Health Commissioner Stella Kyriakides and the Chair and MEPs from the EU Parliament’s Special Committee on Beating Cancer (BECA), as well as other policymakers, healthcare professionals and patient advocates who are concerned about the negative impact of Covid-19 on Cancer.
Launch event webpage:
https://www.europeancancer.org/events/111:time-to-act-launch-event
The campaign recommends specific measures and actions to be taken by the member states of the European Union to re-imagine cancer services in the midst of ongoing Covid-19 pandemic and to prevent a new cancer epidemic in its wake.
Some of the potential impacts of Covid-19 on cancer epidemiology are shown below:
- An estimated one million cancer cases could be undiagnosed in Europe.
- An estimated 100 million cancer screening tests were not performed in Europe during the pandemic, leading to later stage diagnoses and decreased overall survival.
- Up to 1 in 2 people with potential cancer symptoms were not urgently referred for diagnosis.
- 1 in every 5 cancer patients in Europe is currently still not receiving the surgical or chemotherapy treatment they need.
Further data on this can be accessed via: https://www.europeancancer.org/timetoact/impact/data-intelligence
As the second most common cancer in Europe, more than 500,000 colorectal cancer cases are diagnosed every year. Screening and early diagnosis are essential in colorectal cancer treatment and have substantial influence on the prognosis of the disease. The negative impact of the Covid-19 pandemic on patients with colorectal cancer is enormous, and it is necessary for the societies to be more active and achieve extensive collaborations to achieve optimal management of cancer services in the midst of a pandemic.
Interview
Nagendra Dudi-Venkata/Yongbo An: Firstly, we sincerely thank you for accepting the invitation to do this interview and share your insights on the Time To Act Campaign. If we can start the interview by requesting, you to elaborate on the Time To Act campaign? How is this campaign beneficial to patients and health care workers?
Antonino Spinelli: The Time to Act Campaign is an international event organised by the European Cancer Organisation launched on the 11 May 2021 in 30 languages. Since the first wave of the Covid-19 pandemic, there have been concerns about the management of cancer patients. Clinicians across Europe saw 1.5 million fewer cancer patients in the first year of the pandemic and 100 million cancer screening tests were not performed due to the pandemic. All the centres involved in cancer care have experienced a delay in providing patients with timely diagnosis and treatment, mainly for two reasons: first, because the patients were concerned about the impending pandemic, therefore, skipping the regular screening and early diagnostic tests; and second, because the diagnostic-therapeutic oncological pathways were entirely subverted by the management of the infection in hospitals.
This has led to the initiation of this broad awareness campaign on this topic by European political authorities. The event’s spirit is to tackle cancer by promoting prevention, early diagnosis, and treatment across the population. The campaign aims to give the population easier and faster access to screening and treatment services.
As secretary of the European Society of Coloproctology, I think it is crucial that all health professionals working in the field of coloproctology understand and implement the principles of the campaign for the benefit of the patients.
NDV/YA: How many European countries have participated in the campaign? What kinds of new collaboration models that could be organised amongst the member countries under the lead of the campaign?
AS: The campaign will be active at a pan-European level, starting from 34 professional societies and 20 patient advocacy groups with the aim to gain support and consensus to expand to as many health care professionals’ societies as possible. It is of paramount importance to reach health professionals and patients at all levels. The reduction of the cancer burden in the population and the outcomes improvement in cancer patients can only be achieved if there is an excellent widespread multidisciplinary and multi-professional integration. The barriers must be broken down.
Some key aspects of cancer management in which the member European countries can collaborate under the leadership of the campaign are summarised as follows:
- Creating common and standardised pathways for the management of cancer patients.
- Creating research collaborations.
- Tackle medicines, products, and equipment shortages
- Promote technologies overcoming economic and cultural barriers for screening and treatments
- Embed data collection and the rapid deployment of cancer intelligence to enhance policy delivery
NDV/YA: How has COVID-19 impacted colorectal cancer?
AS: COVID19 pandemic strongly impacted the cancer treatment and surgery in all the specialities including colorectal cancers. During the pandemic, there was not only a reduction in referrals for suspected cancer, but we have also witnessed a drastic decrease in the number of colonoscopies, and operations performed for colorectal cancer especially so in particular laparoscopic procedures. . During this pandemic, there also seems to be an rise in stoma formation procedures and an increased uptake of neoadjuvant radiotherapy for rectal cancer in some institutions. But most worryingly, colorectal cancer-related deaths have increased compared to the pre-pandemic period, due to the diagnostic delay. Personally, I have, since the very beginning, been a advocate to avoid lowering our European high-quality standards of cancer care due to the pandemic.
NDV/YA: What significant changes have occurred in the management of these cancers?
AS: The pandemic significantly impacted the management of colorectal cancer at all stages in the diagnostic and therapeutic pathways. It overwhelmed the hospitals, causing a sharp division of pathways between infected and uninfected patients. This led to a reduction in the resources available to patients already in elective cancer treatment setting. The pandemic has posed a massive logistical challenge in keeping the patients and staff safe and maintaining essential care for cancer patients.
Furthermore, many patients delayed screening and follow-up visits due to fears of contracting the infection in hospitals and this resulted in an increase in patients with more advanced cancer burden who needed management in a higher risk environment during the pandemic. In addition, some patients have been delayed in treatment due to the infection itself. Therefore, the pandemic has led to a rearrangement in the management strategies for colorectal cancer patients. Many centres increased the use of bridge-to-surgery strategies, thus reducing the number of patients who underwent early radical surgery. Fewer patients could benefit from curative cancer treatments during the pandemic than during the pre-pandemic era, leading to an increase in tumour-specific mortality.
The Time To Act campaign aims to reverse the above-mentioned trend and enhance the role of prevention and early treatment for cancer patients.
NDV/YA: What major collaboration work has the ESCP organised and accomplished in tackling colorectal cancer during the COVID-19 pandemic?
AS: During the pandemic, ESCP played a central role in conveying information between colorectal surgeons. The outbreak was completely unexpected, and all health professionals were unprepared to face such a global event that impacted the entire health system. In fact, the impact that the virus had on the management of colorectal cancer patients was not yet clear at the time. The ESCP has already promoted international research initiatives to investigate the impact of the pandemic on colorectal cancer surgery. The CovidSurg collaborative originated as part of a global research project promoted by GlobalSurg to examine the effect of the pandemic on cancer surgery around the world. The ESCP supported these collaborative projects, as it believed that research is critical in improving clinical practice during the pandemic era. It is through one such collaborative study, we came to know that an astonishing rate (37.7%) of all cancer operations were cancelled during the pandemic peak and, in particular, 35.9% of them were colorectal cancer.
NDV/YA: As an active global colorectal community, are there any potential impacts of the pandemic on the way the ESCP has engaged with its members during the pandemic?
AS: All the scientific societies needed to cope with the pandemic lockdown. The genuine social time of the meeting has now given way to spending time on the social media and webinars at distance. Although the ESCP has always been linked and connected as a society, the pandemic era was a hard time for human relationships and connections. Moving from the problems that the scientific world faced during the pandemic, ESCP is trying to understand how COVID will impact the future practice in colorectal surgery in the post-pandemic period. The strength of establishing a strong platform of interpersonal relationships through the ESCP is the fundamental prerequisite for facing the challenges of the post-pandemic period together.
One must also admit that there are always some positive aspects as well, even in such a difficult situation: e.g., the fast rise of telemedicine and other digital solutions which has made engagement with wider global colorectal community feasible as elucidated with this very interview which has been conducted by enthusiastic trainees sitting across different time zones.
NDV/YA: Finally, how is the ESCP be involved in the Time to Act campaign and what are the important roles you are playing as the lead from the ESCP in this important initiative?
AS: ESCP has always been committed to promoting the best surgical colorectal practice and is ready to be proactive in the #TimeToAct campaign. Raising awareness of the problem is a priority, so ESCP will promote the campaign through social media, the SoMe profiles and the annual scientific meetings. The political world should also be sensitised on this issue.
Time to Act is a call to arms of cancer prevention and early diagnosis. Building on the lessons learned from the pandemic, we need to develop new cancer patient’s management strategies in line with the times. On one side, ESCP is encouraging citizens to undergo CRC screening and early diagnosis protocols; while on the other side, the society promotes education to improve surgical care through our many Education committee initiatives.
ESCP also believes that the research is a key point: our Research Committee is collecting further data and collaborating in multicentre studies to guide our policy response to the pandemic and post-pandemic period in colorectal cancer management and treatment. Our Communications Committee is a driving force capable of leading and coordinating the campaign within the society.
To conclude, I strongly reiterate the message given by EU Health Commissioner, Stella Kyriakides,
"Cancer takes time away from us. it will not wait for the COVID-19 pandemic to be over. So please. Do not wait. Do not waste time. Visit your doctor. Go for your checkup. Go to screening appointments. Your health services will do all they can to keep you safe."
The ESCP will be part of the campaign to help patients with colorectal cancer.
