1. Eastman, Peggy

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Results from the fourth annual National Cancer Opinion Survey from the American Society of Clinical Oncology (ASCO) show that the COVID-19 pandemic has had a devastating effect on cancer screening. Nearly two-thirds of Americans (64%) scheduled for a cancer screening during the pandemic reported that their test was delayed or cancelled. Among those, two-thirds (66%) said it was their choice, and 63 percent said they were concerned about being behind on cancer screening.

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Survey data show that the pandemic has had a high emotional impact on people with cancer. The survey also shows that nearly six in 10 Americans (59%) believe racism can affect the health care someone receives, with African Americans and other minorities more likely to hold that view. This year's survey, done by the Harris Poll, was conducted online from July 21 to September 8, 2020 in a representative sample of 4,012 U.S. adults aged 18 and older. Among respondents were 1,142 adults who currently have or have had cancer.


Needs & Opportunities

The purpose of the survey was "to capture Americans' views during a time of both a devastating pandemic and a national movement for racial justice," said ASCO President Lori J. Pierce, MD, FASTRO, FASCO. "Our goal is to better understand public perceptions and address urgent needs and opportunities," added Pierce, a radiation oncologist who is Professor and Vice Provost for Academic and Faculty Affairs at the University of Michigan, and Director of the Michigan Radiation Oncology Quality Consortium.


"While delaying recommended screenings for a few months is not necessarily dangerous, our biggest concern is that a significant number of Americans might stop getting preventive care for long periods of time or altogether," said ASCO Chief Medical Officer Richard L. Schilsky, MD, FACP, FSCT, FASCO. He stressed that "cancer screenings are critical for detecting cancer early, and early detection is key to successfully treating many cancers. We need to make sure people continue to get their routine, evidence-based cancer screenings within a reasonable time period."


In addition to believing that racism can affect the health care a person receives, African Americans are much more likely to believe there is unequal access to cancer care in the United States, according to survey data. Fully 71 percent of Black adults (compared to 47% of Whites) said that African Americans are less likely to have access to the same quality of cancer care as White American adults.


Despite these views, the survey shows there is a disconnect when it comes to cancer survival. A minority of Americans-whether Black or White-believe there is a relationship between race and cancer survival, despite data showing that Blacks have the highest death rate and shortest survival of any racial group for most cancers. Fewer than one in five respondents (19%) believes race has an impact on the likelihood a person will survive cancer, with Blacks (27%) and Hispanics (22%) much more likely than Whites (16%) to be aware of the connection between race and cancer survival. But a majority of Americans are aware of the link between health insurance and cancer survival; more than half of respondents (56%) said a person's health insurance type or status has an impact on the likelihood they will survive cancer.


"Racism undermines public health, and it specifically affects patients with cancer," said Pierce. "For almost every cancer, Black Americans fare worse than other racial groups. Now is the time to address the systemic issues of health inequity that negatively impact the health of Blacks and other people of color in our country."


As previously reported in Oncology Times, a new report from the American Association for Cancer Research (AACR) on cancer health disparities shows that members of racial and ethnic minorities have higher death rates from certain cancers than White Americans. They also are often less likely to receive the standard of care recommended for the type and stage of cancer with which they have been diagnosed. The AACR issued a call to action to eliminate cancer health disparities.


ASCO recently released a policy statement on health equity, with an editorial by Pierce. She said, in part, "It is time to dig deeper. To do right by the patients we serve, we must confront and address the complex forces and systems that have created disparities in disease prevention, treatment, and research participation."


The ASCO opinion survey shows that Americans are still not adopting measures to prevent cancer in their daily lives. As shown in previous ASCO surveys, fewer than half of respondents say they do the following to reduce their risk of developing cancer: using sunblock (48%); limiting their exposure to the sun without sunblock (47%); maintaining a healthy weight (47%); and limiting their consumption of alcohol (42%).


As previously reported in Oncology Times, the AACR's 2020 progress report on cancer also shows that Americans are not doing as good a job as they could to prevent cancer, pointing out that today some 40 percent of cancer cases are estimated to be due to preventable causes.


In this opinion survey, 81 percent of people with active cancer said they were limiting their contact with others because of fear of contracting the coronavirus. Patients with active cancer also reported the following: six in 10 (58%) said they have had to make considerable sacrifices in their daily lives because of a heightened risk of COVID-19 (Black patients [61%] are more likely than White patients [47%] to report making these sacrifices); nearly half of patients with active cancer (45%) said the pandemic has had a negative impact on their mental health; and four in 10 patients with active cancer (42%) said they wish they had more emotional support during this pandemic.


COVID-19 Survey Available

As previously reported in Oncology Times, ASCO has launched the ASCO Survey on COVID-19 in Oncology Registry, a clinical trial which collects baseline and longitudinal data on COVID-19's impact on cancer patients, with the goal of influencing patient care.


"For people living with the challenges of cancer, the pandemic is adding a layer of hardship above and beyond what they would normally experience-from feelings of isolation to stress and anxiety," said Pierce. "We urge every American with cancer and their family members to seek out the support they need to the greatest and safest extent possible."


She pointed out that online resources such as ASCO's patient information website, Cancer.Net, provide information to help patients cope with COVID-19.


As has been shown in other studies, this opinion survey found that Americans have misunderstandings about cancer clinical trials. While three in four (75%) said they would be willing to participate in a clinical trial if they were diagnosed with cancer, they also reported the following:


* Nearly half of all respondents (48%) believe patients with cancer who are participating in clinical trials are not receiving the best possible care. They do not understand that clinical trials usually provide one of the most advanced treatments available or a therapy believed to be better than the current standard of care-and in many cases may provide a treatment option when no other options exist.


* Three-quarters of Americans (75%), including 87 percent of patients with cancer, believe that some people who participate in cancer clinical trials receive a placebo rather than an active therapy. But placebos are extremely rare in cancer clinical trials; the majority of trials compare a new therapy to the current standard of care.



Schilsky said the misunderstandings about cancer clinical trials need to be dispelled. "Of the nearly 2 million people who receive a cancer diagnosis each year in the United States, less than 5 percent of adults enroll in clinical trials," he said. "This is due in part to pervasive and persistent myths about trials and concerns that they are only a last resort.


"We need to do a much better job of educating our patients about the benefits of clinical trials. The fact is that clinical trials often offer patients the best-or sometimes only-treatment option for their condition, and these trials offer hope to individuals and at the same time are also the best way to make progress against cancer for everyone."


Peggy Eastman is a contributing writer.