Some say COVID-19 is an equal-opportunity disease, bringing suffering to all corners of the globe. But the virus does not play fair – it disproportionately preys on the vulnerable, including those with cancer. Liquid biopsies help even the odds.
 

Time can be a matter of life and death for cancer patients. Early detection and treatment are essential to improve outcomes, and consistent care is crucial. But the pandemic puts cancer patients at increased risk in three ways:

  • A trip to the nearest hospital can be more than a day of arduous travel for patients in rural regions, even in normal times. In the early months of the pandemic, access to healthcare changed for nearly everyone, and infrastructures – from transit to healthcare – broke down.
  • Lockdowns and overburdened hospitals prevent patients from seeking testing or treatment. Some are simply too scared to go, even if they could.
  • For cancer patients – who are immunocompromised – the risk of infection from COVID-19 and other diseases is particularly high, especially in overcrowded spaces.

Since the pandemic, government and academic institutions report massive declines in cancer care globally. One study shows that nearly 61% of oncology centres across 18 countries reported reduced clinical activity during the first peak of the pandemic, and nearly two-thirds cited under-treatment as a major concern.

Data presented at the ESMO Virtual Congress 2020, in that same study, shows that treatments most likely to be cancelled or delayed at cancer centres were surgery at 44%, chemotherapy at nearly 26% and radiotherapy at nearly 14%. Palliative (quality of life) care ended earlier in 32% of centres.

Regular screenings plummeted, too, reducing the odds of early detection, which translates to decreased survival odds for those diagnosed at a later stage.

Other studies suggest a roughly 80% drop in March and April 2020 in the U.S. alone, in routine screening appointments that could catch new cancers. Another paper estimated that screening for breast, colon and cervical cancer in the U.S. dropped by about 60% from mid-March to mid-June 2020.

 

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“For patients, it's all about time with cancer … in this phase of their disease journey, time matters more than anything.”

            Paulo Neto
            Customer Experience Lead for Personalised Healthcare and Foundation Medicine, part of the Roche Group
 

Finding solutions for those in need

Roche affiliates around the world recognised early that cancer patients were among those being left behind in the race to combat the pandemic. And they were determined to find new and innovative ways to help.

“The situation in Italy was difficult; it was one of the most hard-hit countries,” says Luca Lattanzi, Brand Manager of Precision Medicine at Roche.

In some ways, it was the perfect storm for the pandemic: The risk of cancer increases with age, and almost a quarter (23.1%) of Italy’s population is estimated to be 65 years and older – the largest percentage of elderly in Europe in 2019. Research shows that coronavirus is more of a threat to older people, who, if they get the disease, are more likely to have a severe case.

“We learned from our own field force and physicians that cancer patients in Italy were not always able to go to hospitals to undergo testing or treatments,” Luca says. “The first lockdown was the spark that pushed us to think outside the box and come up with a way to help.”

One of the solutions? A liquid biopsy in the form of a simple blood draw, performed directly in the patient’s home by a traveling nurse. The nurse arrives at a specified time, draws two vials of blood and packages them for courier pickup within four hours. The vials are sent to a special lab, which can test a tumour for genomic alterations, giving the doctor and patient greater insight to target treatment options.

 

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How mobile blood draw works

  1. Healthcare provider orders the liquid biopsy test; sends privacy consent forms to patient
  2. Patient signs forms by email or video/audio recording
  3. Patient information is uploaded to a secure system
  4. Nurse arrives at patient home with kit and pre-printed patient form
  5. Nurse performs blood draw, fills the box and seals it, and leaves with any biowaste
  6. The blood sample is refrigerated by the patient and collected by courier within 4 hours.

 

Each cancer, like each person, is unique

Every person has a unique set of genetic instructions, called a genome. Cancer is a disease of the genome, caused by genomic alterations that make a tumour grow. Comprehensive genomic profiling, or CGP, is a powerful tool for proper diagnosis and treatment planning. It tests a tumour’s DNA for more than 300 genomic alterations, and offers a summary of treatment options based on the alterations identified. This gives the doctor and patient options for care that are tailored to the individual causes of the disease.

Comprehensive genomic profiling can be performed through a tissue biopsy, where a tissue sample is taken from the body, which is invasive and must be done in a hospital or clinic. Liquid biopsies (blood draws) give people with cancer a minimally invasive way to identify a targeted cancer therapy. For example, lung cancer patients whose disease has progressed may have less tissue available for biopsy, or the tumour may be in a hard-to-reach location.

“There’s also the mental side of it,” says says Paulo Neto, Customer Experience Lead for Personalised Healthcare and Foundation Medicine, part of the Roche Group. “People are more comfortable and confident in their homes. So the blood draw is in their own space, their place of shelter. That emotional part is very important; we are coming to them on their terms. We are talking about cancer patients, and many of them are already fragile in their condition.”

 

What is liquid biopsy?

Comprehensive genomic profiling with liquid biopsies involves drawing only two vials of blood, and eliminates or minimises time spent in hospitals or clinics. For those who are already weak, it also removes the need to travel long distances for testing. The solution ensures privacy, gives patients safe, timely access to essential diagnostics, and provides invaluable insight to patients and their doctors to help personalise treatment.

 

How liquid biopsy works

Liquid biopsies test for solid tumours; it detects circulating tumour DNA, shed by the tumour, in the patient’s blood. This opens the option for comprehensive genomic profiling to more patients, regardless of where they are located or the circumstances of the pandemic. Every cancer is unique, and this innovation makes truly personalised cancer care a reality for more patients across the globe.