NCCN Cancer Experts Answer Questions About COVID-19 Vaccines
NCCN has published new guidance on COVID-19 vaccines for people with cancer, intended to clear up confusion for patients and caregivers. The new 4-page patient guide is based on the latest expert review of evolving evidence.
“We’re happy to provide plainspoken answers for people with cancer and their loved ones that directly address concerns about the COVID-19 vaccines,” said Robert W. Carlson, MD, Chief Executive Officer, NCCN. “We know people with cancer are particularly vulnerable to COVID-19, and also that vaccination is a safe way to reduce infection. One of NCCN’s biggest strengths is our ability to quickly bring together leading national experts in order to share their collective knowledge and insights on the evidence in straightforward, nonmedical language.”
The newly published guidance for patients and caregivers covers:
- • A brief overview of all approved vaccines in the United States;
- • Answers to Frequently Asked Questions;
- • The importance, effectiveness, and safety of COVID-19 vaccinations in people with cancer and their caregivers, households, and close contacts;
- • An explanation of which specific types of cancer treatments should appropriately result in a slight delay before vaccination; and
- • The importance of continued mask wearing after vaccination for vulnerable populations.
“We want to reinforce that the decision to get vaccinated against COVID-19 should be something that isn’t scary or confusing for people with cancer,” said Brahm Segal, MD, Roswell Park Comprehensive Cancer Center, Co-Leader of the NCCN COVID-19 Vaccine Advisory Committee. “The members of this NCCN committee have devoted our lives to studying how to reduce infectious diseases and improve outcomes in people with cancer. I personally was happy to get whichever vaccine was first available to me; we want our loved ones, patients, and community at large to have that protection too.”
Visit NCCN.org/patientguidelines to access the COVID-19 patient guide and for additional free, trusted resources that empower people with cancer and their caregivers with unbiased guidance from some of the world’s leading cancer experts.
Updated Recommendations on COVID-19 Vaccination for Oncology Care Providers
The new patient resource is launching alongside new updates to the NCCN: Cancer and COVID-19 Vaccination recommendations for healthcare providers, which were first published in January 2021. The newly updated clinician guidance was published at NCCN.org/covid-19 on June 9, 2021, and includes emerging information on vaccination in younger people plus discussions around vaccine effectiveness in people with cancer.
The updated clinical recommendations include a note about counseling patients with a history of heparin-induced thrombocytopenia and/or thrombosis to consider mRNA vaccines instead of the AdV-type 26 vector vaccine. The committee also cautions against antibody testing outside of a study, and encourages more research on the topic of booster shots.
Visit NCCN.org/covid-19 to learn more about how the coronavirus interacts with cancer, including documents, videos, and self-care tips in English, Spanish, and Chinese. Learn why experts agree that recommended cancer screenings are safe and essential, now more than ever.
New Patient Guide From NCCN Jumpstarts Important Conversations About Anal Cancer
NCCN has published new NCCN Guidelines for Patients Anal Cancer, in addition to recently updated patient guidelines for colon and rectal cancers. These new and updated resources are made possible through the NCCN Foundation. The books provide unbiased guidance from leading experts that provide people with cancer and their caregivers with a baseline understanding of management options and empower them to ask questions of their healthcare providers—particularly regarding complicated, stressful, or stigmatized topics.
“Facing an anal cancer diagnosis can be overwhelming and filled with uncertainty. That’s why ACF partnered with NCCN to translate its evidence-based, expert-consensus clinical guidelines from the leading cancer hospitals in the country into a patient-friendly format,” said Justine Almada, Co-Founder and Executive Director of the Anal Cancer Foundation, which sponsored publication of the new NCCN Guidelines for Patients: Anal Cancer. “This comprehensive guide empowers patients and their caregivers by providing them access to the same information as their doctors. The more individuals and families understand about anal cancer, its treatment, and side effects, the better prepared they are to actively participate in their care and have meaningful conversations with their medical team about treatment and recovery.”
“Patients with cancer in general need access to the most reliable, up-to-date information possible,” explained Al B. Benson III, MD, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chair of the NCCN Guidelines Panel for Colon/Rectal/Anal Cancers. “The NCCN Guidelines for Patients provide a framework for discussion and help people to formulate questions, while not replacing the personal interactions between a patient and their medical team.”
“Clinical trials are helping us to understand the growing role for immunotherapy in treating anal cancer,” added panel Vice Chair Alan Venook, MD, UCSF Helen Diller Family Comprehensive Cancer Center. “We’re trying to get away from more toxic forms of chemotherapy that had been standard of care for this disease type for more than 50 years. Patients are also often surprised to learn that we most often avoid surgery when treating anal cancer, unlike in colon and rectal cancers.”
According to the NCCN Guidelines for Patients: Anal Cancer:
- • Anal cancer incidence is on the rise in the United States and is strongly linked to the human papillomavirus (HPV)
- • Chemoradiation is the recommended primary treatment for most patients with nonmetastatic anal cancer
- • Immune checkpoint inhibitors are an option for second-line therapy with metastatic disease
“No one should ignore symptoms or family history, because unfortunately we’re seeing many of these young patients diagnosed at later stages,” said Dr. Benson. He and Dr. Venook cautioned that no one should be considered “too young” to be tested for colon, rectal, or anal cancers if they experience bleeding, significant weight loss/changes in bowel habits, or have an immediate family member diagnosed with one of these cancers.
Drs. Benson and Venook both stressed the importance of young people getting vaccinated against HPV in order to reduce their chances of developing anal cancer, along with cervical, oropharyngeal, and other cancer types.
The NCCN Guidelines for Patients are based on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines), which are created by multidisciplinary teams of experts from across NCCN Member Institutions. NCCN Guidelines are the recognized standard for clinical direction and policy in cancer care and the most thorough and frequently updated clinical practice guidelines available in any area of medicine. The patient versions are presented in easy-to-read language and format—with charts, images, and a glossary of medical terms—and were found to be among the most trustworthy options for patients with cancer seeking information online according to a recent independent study.
There are now more than 50 different books for patients and caregivers from NCCN covering every major type of cancer, along with topics like managing cancer-related distress, nausea and vomiting, and survivorship (both healthy living and cancer-related late and long-term effects), plus special considerations for adolescents and young adults across all cancer types. Printed versions are available for a nominal fee at Amazon.com in addition to the free digital versions at NCCN.org/patients.
NCCN Maintains Qualification as CMS-Approved Provider-Led Entity for the Development of Imaging Appropriate Use Criteria
NCCN has again qualified as a provider-led entity (PLE) for the Medicare Appropriate Use Criteria (AUC) Program by Centers for Medicare & Medicaid Services (CMS), the nation’s largest health payer. NCCN earned its initial qualification in 2016 when CMS launched the new program to increase the rate of appropriate advanced diagnostic imaging services provided to Medicare beneficiaries. NCCN was recognized as one of the first groups qualified to develop AUC that can facilitate decision-making for diagnostic imaging in patients with cancer. PLEs are qualified for a period of 5 years, and, after close review of the 2021 renewal application, CMS determined that NCCN continues to meet the requirements to be a PLE. NCCN Imaging Appropriate Use Criteria (NCCN Imaging AUC) are accessible for free to registered users of NCCN.org through an easy-to-use database at NCCN.org/ImagingAUC.
“NCCN is honored to remain among the distinguished group of CMS-approved provider-led entities for development of diagnostic imaging AUC,” said Robert W. Carlson, MD, Chief Executive Officer, NCCN. “This recognition advances NCCN’s commitment to high-quality care while assuring the appropriate use of advanced diagnostic imaging for people with cancer. During the last 5 years, we have greatly expanded the library of evidence-based recommendations in the NCCN Imaging AUC and we will continue to update and enhance this resource based on scientific and medical advances.”
NCCN Imaging AUC are based directly on the NCCN Guidelines and include recommendations pertaining to cancer screening, diagnosis, staging, treatment response assessment, follow-up, and surveillance. Additional information includes the indication, imaging modality, and frequency of use, as well as clinical notes related to each specific recommendation. NCCN Imaging AUC also include information on disease stage and histology. All imaging procedures recommended in the NCCN Guidelines, including radiographs, CT scans, MRI, functional nuclear medicine imaging (PET, SPECT), and ultrasound, are included within NCCN Imaging AUC.
NCCN Imaging AUC are available for more than 67 cancer types in addition to screening and supportive care. Additional NCCN Imaging AUC will be published in the coming months. To access the NCCN Imaging AUC and view a user guide, visit NCCN.org/ImagingAUC.
NCCN Policy Summit Explores How COVID-19 Pandemic Can Lead to Improvements in Cancer Care
On June 15, 2021, NCCN hosted a virtual NCCN Policy Summit examining the impact of the past year on oncology policy in America. The program, “Defining the ‘New Normal’— 2021 and the State of Cancer Care in America Following 2020,” brought together a diverse group of experts to discuss the resumption of recommended screening and clinical trials, how to apply health innovations from the COVID-19 pandemic to cancer treatment, and what concrete steps can be taken to address the systemic inequalities that lead to disparities in outcomes.
“The medical community has proven that rapid, extraordinary progress can be made when we respond to a threat like the COVID-19 pandemic with the urgency, focus, and collaboration it demands,” said Crystal S. Denlinger, MD, Senior Vice President, Chief Scientific Officer, NCCN. “We have the opportunity to improve cancer treatment and research by not just reverting to prepandemic standards, but reimagining how we move care forward. We’ve learned a lot over the past year about how to do better when it comes to providing healthcare; now we must apply that knowledge to oncology.”
“Partnership drives equitable care, and the CMS Office of Minority health is committed to advancing collaboration for all our beneficiaries and consumers,” said LaShawn McIver, MD, MPH, Director, Centers for Medicare & Medicaid Services (CMS) Office of Minority Health. “The current public health emergency illuminates the barriers we’ve broken down, and those we still must overcome—particularly for people hard hit by health disparities. Opportunities like the NCCN Policy Summit underscore both the importance and breadth of collaboration needed across healthcare to advance equitable solutions.”
The speakers and panelists presented some of the latest data on health trends over the past year, while cautioning that much of that research is still early and ongoing. Some key areas of focus included:
- • Reducing barriers that prevent people from getting recommended health screenings and care in a timely fashion
- • Maintaining telehealth options wherever beneficial to patients (eg, survivorship care)
- • Utilizing electronic health records (EHRs) as a patient/provider portal for communication
- • Funding the resumption of the basic science research pipeline for clinical trials
- • Leveraging real-world evidence to broaden knowledge beyond the typical clinical trial population
- • Recognizing and addressing bias and lack of diversity in medical care providers
- • Addressing the social determinants of health that result in disparities in outcomes
“Cancer Care in the United States has evolved in the face of a global pandemic,” said Timothy Kubal, MD, MBA, Senior Medical Director, Moffitt Cancer Center, Co-Chair of the NCCN Best Practices Committee. “Despite this evolution in practice and process, each day we continue to lose the lives of people we love. The purpose of policy change is to lead us somewhere different; to take us to a better place where those lives are saved instead of lost. Our world has changed; our policy cannot stay the same.”
NCCN is actively involved in several initiatives addressing some of the issues discussed, such as:
- • Cancer Won’t Wait and Neither Should You: an endorsement of the safe resumption of cancer screening and treatment, jointly with the American Cancer Society and 75 other cancer organizations.
- • Elevating Cancer Equity: Recommendations to Reduce Racial Disparities in Access to Guideline Adherent Cancer Care, in collaboration with the American Cancer Society Cancer Action Network, and the National Minority Quality Forum
- •
NCCN Best Practices Webinar Series: a series on COVID-19 and Cancer Center operations
Additional speakers included:
- • Murray Aitken, MBA, Executive Director, IQVIA Institute for Human Data Science
- • Jeff Allen, PhD, President and Chief Executive Officer, Friends of Cancer Research
- • Keysha Brooks-Coley, Vice President, Federal Advocacy and Strategic Alliances, American Cancer Society Cancer Action Network
- • Jennifer Malin, MD, PhD, Chief Medical Officer, Oncology & Genetics, UnitedHealthcare
Additional quotes:
Sarah Alwardt, Vice President of Operations at Ontada says:
“Although we do not yet know the full impact of COVID-19, one clear outcome has been the massive public education on the importance of real-world evidence in clinical trials. We have now reached the tipping point in using real-world data to accelerate trial design and populations. We’ve demonstrated that this real-world evidence can be trusted and I hope that we ensure this momentum carries forward.”
Shonta Chambers, MSW, Executive Vice President of Health Equity Initiatives and Community Engagement, Patient Advocate Foundation says:
“As we think about elevating cancer equity, we can’t ignore the impact of the social determinants of health hindering people’s ability to access and adhere to cancer care. These determinants have political underpinnings that continue to perpetuate disparate outcomes among populations of color. We have to systematically assess social needs gaps in the content of healthcare delivery for all patients, and create sustainable partnership and collaborations with entities best positioned to respond to them locally and nationally. Healthcare outcomes are not limited to the four walls of the healthcare systems, we must account for the social context of one's healthcare and act on tangible solutions to respond to them. That is how we elevate cancer equity for everyone.”
Jennie Crews, MD, Vice President and Medical Director, SCCA Community and Network Programs, at Seattle Cancer Care Alliance says:
“The COVID-19 pandemic is driving rapid innovation in cancer care delivery which will continue to influence how cancer care evolves going forward. Seattle Cancer Care Alliance, like many of our peers across the nation, quickly adapted to incorporate the rapid pace of knowledge and data around COVID-19, modified clinical care and clinical trials, and addressed issues such as disparities in access to care. We experienced rapid and widespread adoption of virtual care for patient visits and monitoring, allowing SCCA to continue to provide care in ways that met patient needs through nearly 30,000 virtual visits.”
Gwen Darien, Executive Vice President for Patient Advocacy and Engagement, National Patient Advocate Foundation says:
“Two years ago, we were all talking about personalized medicine. As a result of the pandemic, I’m increasingly interested in talking about personal medicine. How do we create and maintain personal connections when the modern office visit is only 15 minutes? I spent much of my childhood waiting in the car while my dad—an internist in Milwaukee—made house calls. He knew his patients so well. Telehealth is still in its nascent form, so we have the opportunity to sculpt it into a contemporary house call, allowing health care providers to see the challenges and barriers patients face and the social context of their health.”
Pamela Kunz, MD, Vice Chief, Diversity Equity and Inclusion, Medical Oncology, Director for the Center for Gastrointestinal Cancers, Yale Cancer Center and Smilow Cancer Hospital says:
“In order for us to provide equitable patient care, we also need to achieve diversity and equity in our professional workforce. These are inextricably linked.”
Christopher Lathan, MD, MS, MPH, Chief Clinical Access and Equity Officer, Dana-Farber Cancer Institute says:
“What we’ve learned from the COVID experience is when we want to, we are able to recruit diverse patients to clinical trials. This shows that these barriers can be overcome with resources and willpower. If we really want to ensure our vulnerable patients are reengaging with preventive and diagnostic services, we must have the will and resources to support them appropriately.”
Andrea D. Willis, MD, MPH, FAAP, Senior Vice President and Chief Medical Officer, BlueCross BlueShield of Tennessee says:
“The COVID crisis taught us that we can make things happen when we all rally around a cause. The call to reduce health disparities when it comes to cancer treatment and prevention is not a new one but the momentum we currently have to realize health equity requires a stronger response.”
The next NCCN Virtual Policy Summit will take place on Thursday, September 9, 2021, and focus on ‘The Impact of Technology on Cancer Care in 2021.’ For more information, visit NCCN.org/summits and join the conversation with the hashtag #NCCNPolicy.
