May 08, 2020
During the pandemic, cancer patients undergoing treatment or participating in clinical trials at The University of Kansas Cancer Center don’t have to worry about whether or not they can get a test for the novel coronavirus that causes COVID-19.
The research arm of KU Cancer Center stepped up to allow patients to opt-in to a study that provided the test in recent weeks and also covered its cost. It is just one of the many ways KU Cancer Center is working to fight the pandemic.
Roy Jensen, MD, director of KU Cancer Center, said coronavirus testing is especially important for cancer patients.
“These patients have a higher risk of becoming infected, and the subsequent symptoms can be more severe if they are. Many of the treatments for cancer also can suppress the immune system, which needs to be at full strength to combat the virus,” he said.
“Since it’s becoming clear that asymptomatic patients can be carriers of the virus, testing is now more critical than ever,” Jensen added.
Testing is now available as a standard procedure for cancer center patients through The University of Kansas Health System. The hospital’s laboratory can then provide results in about 24 hours, handling billing normally.
A few weeks ago, however, this option was unavailable. Tests weren’t available for asymptomatic individuals, even those who had cancer. So, KU Cancer Center’s research arm stepped up to help.
Unique organization finds unique solution
While KU Cancer Center is known for its research designation as a National Cancer Institute (NCI) Center, many people may not realize that it is a unique organization that includes both research and patient care. As such, it is a part of both the University of Kansas Medical Center and The University of Kansas Health System. In the initial stages of the COVD-19 pandemic, patients with cancer really benefited from that cooperation.
Prior to tests being available through the health system, more than 500 cancer patients received coronavirus tests at no cost to them because of a clinical trial conducted through the research arm of KU Cancer Center.
To access the test, patients could opt into a registry led by Weijing Sun, MD, associate director for clinical research at KU Cancer Center and a practicing oncologist with The University of Kansas Health System. The registry tracked the COVID-19 test results and the cancer-treatment timeline of patients testing positive for COVID-19. The cancer center’s research budget paid for the cost of the test.
Sun, also a professor of medicine and director of the division of medical oncology at KU Medical Center, plans to analyze the data to help doctors and researchers understand the overlap of the two diseases to develop subsequent treatment plans.
“While a logical solution might be to hold off on anti-cancer therapies during the COVID-19 pandemic, this is far from simple,” Sun said. “There is a wealth of data demonstrating that delayed diagnosis and treatment initiation for many cancers results in significantly worse survival, among other outcomes.”
Clinical trial participants who tested positive for COVID-19 had discussions with their physician and treatment team to determine best next steps. They weighed the risks of treating the patient who was COVID-19 positive versus delaying treatment until the patient recovered from COVID-19. The study offered follow-up testing until the clinical trial participant tested negative.
Jensen said the relationship between research and clinical care was a stairstep approach that continues to benefit cancer patients.
“While the clinical trial is now closed to new participants, that data remains, and new cancer patients will be able to access coronavirus tests through their health care providers,” he said.
These patients have a higher risk of becoming infected, and the subsequent symptoms can be more severe if they are, Many of the treatments for cancer also can suppress the immune system, which needs to be at full strength to combat the virus. Since it's becoming clear that asymptomatic patients can be carriers of the virus, testing is now more critical than ever. Roy Jensen, MD, director of KU Cancer Center
Finding yet another local partner
Tests conducted as part of the clinical trial were performed at Sinochips Diagnostics, a clinical reference laboratory located on the KU Medical Center campus and another initiative that’s grown out of the KU Cancer Center.
The lab, which only opened in August 2019, changed direction in March 2020 to begin performing COVID-19 testing six days a week, said Andrew Godwin, PhD, deputy director of KU Cancer Center and professor and director of molecular oncology in the department of pathology and laboratory medicine at the KU Medical Center. Godwin is also a co-founder of Sinochips Diagnosis, a recent spinout from the university focused on pharmacogenomics testing.
He said he offered to provide KU Cancer Center with testing at cost because of sense of duty to the place he calls home.
“We were able to retool our whole shop in a fairly rapid period of time just to address the needs in our community,” Godwin said.
Testing helps patients and KUCC staff
Natalie Streeter, M.S.N., executive director of clinical research, strategy and operations at KU Cancer Center, said testing cancer patients was a win-win situation for patients, researchers and patient care staff.
Cancer patients, already carrying the heavy mental burden of a cancer diagnosis, had at least one uncertainty removed from their minds – whether they were also harboring the coronavirus. Clinical staff benefited from knowing the COVID-19 status of their patients while providing life-saving cancer treatments.
“It’s a win for the clinics, because if patients are coming into their facilities asymptomatic, they could be infecting their other patients, physicians and staff. If these patients and clinical trial participants are negative for COVID-19, that gives a bit of reassurance to show that we’re doing one more thing to protect everyone.“
Cancer patients included in national registries
KU Cancer Center also is participating in three registries currently tracking how COVID-19 affects individuals with cancer. These three databases will then form study pools for clinicians and scientists.
“In Kansas, we have been pretty lucky that our number of patients with cancer and COVID-19 is relatively small,” Streeter said. “So, in order to get some meaningful data, we need to partner up with other academic and research organizations.” With enough data, she explained, researchers may be able to suggest best practices for patient care. This will be particularly valuable if the virus returns in force in the fall or lingers for a long time without a vaccine.
KU Cancer Center is working with registries from the American Society of Clinical Oncology (ASCO); the COVID-19 and Cancer Consortium, led by Vanderbilt University; and a local KU Cancer Center registry developed by Dr. Weijing Sun. A fourth registry is slated to open later this spring through the National Cancer Institute, a division of the National Institutes of Health.
Cancer-fighting tactics prove helpful in battling COVID-19
KU Cancer Center also has been helping efforts during the pandemic by providing a template for KU Cancer Center, The University of Kansas Health System and the University of Kansas Medical Center to work together on COVID-19 clinical research. KUCC runs 12 disease working groups, bringing together physician scientists, translational scientist and research staff in various clinical areas. This organizational structure bridges medical research and patient care. Members of the three organizations saw the need to meet regularly and create avenues for research cooperation for the patients’ benefit. The KUCC DWG template was a model for the COVID-19 Working Group, which also includes all three organizations.
The result, Streeter said, was that the groups could work together quickly. “Cancer treatment trials are very intense, and the people who work on these cancer trials are used to urgency,” she said, noting that is a real plus when dealing with a novel virus like COVID-19.
The Cancer Disease Working Groups also have experience maneuvering through regulations in research and patient care.
“I think the structure of the Cancer Disease Working Groups has lent itself very well to help manage all of these programs for something like COVID-19 that is all-encompassing,” Streeter said.
If people aren’t coming in for their clinical trial appointments, they are getting called to see why they’re not coming in. Are they not coming in because they’re sick, or because they’re scared and worried about leaving the house? We tell them coming in is still in your best interest, because cancer is not waiting for the pandemic to be over. Natalie Streeter, M.S.N., executive director of clinical research, strategy and operations at KU Cancer Center
Still fighting cancer, but more safeguards in place
Most patients and clinical trial participants won’t recognize the behind-the-scenes labors of a working group, but they definitely notice those frontline medical workers responsible for their care during treatment.
They might notice fewer people on their way to an exam or procedure. They might be asked to wait in their vehicle instead of a waiting room. They might have to come alone to appointments when they normally depended on the strength of a loved one.
So, in the defeating-cancer business, it’s business as usual, but not in the usual way, Streeter pointed out.
“If people aren’t coming in for their clinical trial appointments, they are getting called to see why they’re not coming in,” Streeter said. “Are they not coming in because they’re sick, or because they’re scared and worried about leaving the house? We tell them coming in is still in your best interest, because cancer is not waiting for the pandemic to be over.”