Despite reductions in cancer screening, diagnoses and surgeries during the first year of the COVID-19 pandemic, systemic cancer treatment was not substantially affected, Australian research shows.

A population-based study of cancer medicines dispensing, initiations and discontinuations found only small and temporary changes during COVID-19 compared to pre-pandemic levels.

The PBS data showed no significant changes in chemotherapy dispensing but an increase in immunotherapy and targeted therapy dispensing in March 2020 and July 2020.

“There were no notable differences in dispensings of different classes of antineoplastic medicines between the State of Victoria, which was subject to the most restrictive lockdown measures, and the rest of Australia,” the study authors said.

Overall, there was a small increase in antineoplastic medicine initiation in Australia – led by an increase in immunotherapy initiations which was not offset by a decrease in chemotherapy initiations.

A temporary increase in discontinuations of antineoplastic medicines was also seen in April 2020.

Dispensing of endocrine therapy increased temporarily in March 2020, dropped in April and increased again in July. There was a temporary increase in endocrine therapy discontinuations in April 2020, but no changes in endocrine therapy initiation.

There was a sustained increase in the dispensing of granulocyte-colony stimulating factors from March 2020 while other supportive therapies such as ondansetron decreased and other antiemetics were unchanged.

The study, published in The Lancet Regional Health-Western Pacific, said the minimal changes to systemic therapy likely reflected the relatively low number of COVID-19 cases in Australia. The same pattern was seen in New Zealand.

“By contrast, the number of monthly registrations for new systemic anticancer treatments fell by 32% in England in April 2020 compared to the pre-COVID-19 comparison period,” the study said.

The investigators, led by Dr Monica Tang from the University of NSW, said some of the observed changes in systemic cancer therapy in Australia were possibly not related to COVID-19.

Instead, they were more likely related to the timing of new listings on the PBS including nivolumab for melanoma, durvalumab in NSCLC, and atezolizumab in SCLC.

“Despite concerns about the potential for COVID-19 to compromise the clinical care of patients with cancer, effective control of community transmission appears to have mitigated the impact of COVID-19 on cancer medicines use in Australia,” they concluded.