This month, EORTC Imaging Group published a paper1, in the European Journal of Nuclear Medicine and Molecular Imaging, where they outlined the impact of COVID 19 on imaging in oncological trials.
The COVID-19 pandemic has adversely affected many unrelated healthcare needs. The requirement for social distancing and equipment decontamination has slowed imaging procedures especially in clinical cancer trials. Activities considered as non-essential such as quality assurance, technical and biological validation, and PET pharmacokinetic studies were suspended. In comparison for therapeutic trials, study visits and delivery of pharmaceuticals were continued remotely. However, as imaging requires hospital visits, the frequency of imaging patients currently registered within trials were compromised, risking their continuation on ineffective, potentially toxic therapies. The group emphasized that protocol deviations on timing or performance of imaging may introduce bias in treatment effect estimates and/or reduce statistical power by rendering patients not evaluable for the endpoint. Image interpretation of disease progression may be confounded by (sub)clinical infection (COVID-19) related changes. Moreover, the reduction in new cancer diagnoses because of reduced hospital services and lack of adequate baseline imaging, including image-guided biopsies, misses opportunities for new recruitment. Delays can result in oncological progression and patient ineligibility.
The continued need for social distancing and use of personal protective equipment for procedures when healthcare services are resumed slow imaging throughput. Institutions need to develop pathways where imaging studies can be directed to local sites with spare capacity, facilities that exclude potentially infectious patients and semi-automated readouts that reduce staff pressure. The EORTC imaging group conclude that smarter use of imaging within trials and improved communication are needed during pandemics so that cancer research is not restrained by failure to deliver timely imaging, compliant to protocol.
1Impact of the COVID-19 crisis on imaging in oncological trials
Christophe M. Deroose; Frédéric E. Lecouvet; Laurence Collette; Daniela E. Oprea-Lager; Wolfgang G. Kunz; Luc Bidaut; Joost J. C. Verhoeff; Caroline Caramella; Egesta Lopci; Bertrand Tombal; Lioe-Fee de Geus-Oei; Laure Fournier; Marion Smits; Nandita M. deSouza; Eur J Nucl Med Mol Imaging; June 2020 DOI 10.1007/s00259-020-04910-y