We are seeing real-time shifts in oncology care delivery which may stay in place long after the pandemic has passed.

1. COVID-19 marks an unparalleled challenge for
healthcare systems. By redefining elective
procedures and using technology, oncology
practices and the US government are establishing
new ways to manage patients during the crisis.
Now more than ever, oncology stakeholders must
work together to help patients start, continue, or
adjust treatment, and the shifts taking place
during this pandemic may help define a new
normal.
MARCH 2020
Cancer During COVID-19:
Impact on Oncology
Care Delivery and More

2. In order to maintain capacity and treat incoming patients with serious COVID-19 symptoms,
hospitals have drastically re-allocated resources. The new focus on COVID-19 has left
patients with cancer anxious about impending treatments and procedures. Many
procedures are at risk of cancelation to keep immunocompromised patients safe and to
protect hospitals across the country that are functioning with dangerously low levels of
staffing and supplies.
GOVERNMENT PERSPECTIVE*
CASE-BY-CASE OBJECTIVE
Allow oncologists to focus on addressing
urgent cases and preserve resources
needed for COVID-19 response
HOW
CMS and the ASCA outlined patient risk
factors to consider for postponing elective
surgeries and nonessential procedures
PATIENT RISK FACTORS
• Availability of beds, staffing, and PPE*
• Availability of approved alternative
treatment options
• Risk associated with waiting
ONCOLOGISTS WEIGH IN
PROTOCOL-DRIVEN OBJECTIVE
Implement evidence-based protocol to
efficientlyallocate resources and alleviate
oncologist and staff burnout
HOW
Oncology groups are stratifying risk for
delaying or changing treatments of
immunocompromised patients
KEY INSIGHTS FOR PHARMA
Adverse event profiles and real-world data
play a critical role in determining which
procedures are safest as patients with
cancer move outside the clinic for care
JNCCN=Journal of the National Comprehensive Cancer Care Network;ASCA=Ambulatory Surgery Center
Association; PPE=personal protective equipment.
*The Defense Production Act could require manufacturers of any goods to start making PPE and ventilators.
State governments are also urging hospitals to increase bed capacity. New York has mandated a 50% increase
in capacity. Cancelling elective surgeries will be part of this plan, and hospital revenue w ill be impacted.
The FDA has advised it does not intend to fault healthcare stakeholders for failing to adhere
to some REMS procedures during the crisis, but it may continue to require REMS for certain
drugs if the agency deems it necessary to ensure the benefits of the drug outweigh the
risks. COVID-19 responses are constantly updated; hospitals and oncology practices are
learning in real time.
CURRENT SITUATIONIN ONCOLOGY
UNITED STATESRESPONDS
Oncologists and staff may
be less familiar with using
telehealth technologies
than other practices
Cancellations and delays
are made on a case-by-
case basis, and policies
are rapidly changing
within healthcare facilities
JNCCN recommends
reducing unnecessary viral
exposure for
immunocompromised
patients, especially in
early-stage cancers
Oncology professionals and the government are
vigilant about protecting patients with cancer

3. In response to COVID-19, surgical intervention for cancer treatment requires risk-based
prioritization. JNCCN expects surgeries scheduled for patients with early-stage breast or
cervical cancer, thyroid cancer, or prostate cancer to be delayed.
As previously noted, treatment cancellations and delays are being made on a case-by-
case basis, and policies are rapidly changing within healthcare facilities. The Mayo Clinic,
for example, has given the authority to individual care teams to determine treatment paths.
The Seattle Cancer Care Alliance, on the other hand, has published more concrete
guidance on changing cancer care delivery:
SEATTLE CANCER CARE ALLIANCE RECOMMENDATIONS
CANCER/TUMOR TYPE RESPONSE
Solid tumors Adjuvant therapy with curative intent should proceed
Metastatic disease • Therapy delay may lead to loss of the window to
treat
• Consider how delay may lead to clinical
deterioration for patient and subsequent drain on
hospital resources
Early-stage endocrine
cancers
Several months of endocrine therapy and delay in
surgery may be appropriate for some patients
3
Risks associated with waiting
2
Availability of approved
alternative treatment options
1
Availability of beds, staffing,
and PPE
THINK THROUGH THE3:
COVID-19 has forced the oncology
community to redefine “elective procedures”
Cancer Treatment Centers of America (CTCA) is calling on all specialty cancer centers to
become more proactive in response to COVID-19. CTCA is supporting cancer patients from
neighboring acute care hospitals to help hospitals focus on COVID-19. Compassionate
responses like this will help mitigate the risk tor cancer patients without compromising care.
JNCCN=Journal of the National Comprehensive Cancer Care Network

4. Switching patients from IV/injectable drugs
to oral therapies may be prudent
Comparable to what has happened with elective surgeries, cancer organizations like ASCO
have identified opportunities to limit COVID-19 exposure for oncology patients receiving
infusion therapy. However, ASCO warns providers and systems that when it comes to
switching, there are no easy options.
ASCO COVID-19 STATEMENT: “Some patients may switch chemotherapy from IV to oral
therapies to decrease the frequency of clinic visits but would require greater vigilance by
the healthcare team to be sure that patients are taking their medicine correctly.”
Limiting exposure is imperative, but each case much be assessed individually. Switching to
oral oncolytics opens new doors to managing adherence and side effects, a steep learning
curve even without the backdrop of a public health crisis.
The American Cancer Society recommends crafting a care plan before making a switch:
The switch to oral therapy should be well thought out between a care team and a patient.
Nevertheless, reducing unnecessary exposure for immunocompromised patients is warranted,
especially for patients in early-stage cancers (particularly endocrine-related disease) or those
in maintenance stages. Patients with cancer who have other pre-existing conditions like
diabetes or heart disease require extra vigilance during this time.
CARE PLAN
COMPONENT
POTENTIAL
SOLUTION
How and when to take
oral formulation
• Appoint an experienced care manager to teach patients
and caregivers the therapy specifics
• Use telehealth to communicate and keep the lines open
Special handling • Utilize specialty pharmacy to ensure patients and caregivers
understand how to store medication
Side effects and how to
manage them
• Keep regular telehealth appointments that mirror the timing
of side effects
• Blood monitoring for patients can be done in local
laboratories close to home
Cost • Involve payers in the plan early to understand coverage and
cost
• Use manufacturer financial support options

5. Virtual is the new normal for now, but may
have a lasting industry impact
SOCIAL DISTANCING IN CANCER CARE
Although dynamic and expanding, the procedures set in place due to COVID-19 are
pushing providers in a direction that many professionals in the oncology space have hoped
to see. Telehealth can help patients with cancer and practice staff “flatten the curve,” and
may also be the start of lasting change. Jennie Crews of the Seattle Cancer Care Alliance
believes oncologists and staff will be less familiar with telehealth technologies than primary
care providers and recommends oncologists review and build on the best practices that
exist in cancer today. Telehealth practices at Texas Oncology may be worth emulating.
Telehealth was initially developed to reach patients in rural areas with limited access to
healthcare. Some payers, including the US government, have been reluctant to accept
and reimburse for telehealth services. For now, payers will be forced to expand
reimbursement quickly. The US Government has temporarily relaxed telehealth restrictions
for Medicare patients; some states have signed executive orders to cover medically
necessary telehealth services and have prevented payers from adding any restrictions to
these authorizations.
In addition to telehealth visits with patients, oncology practices will look for tools that
enable remote work, especially for non-clinical staff. These could include cloud-based
resources to track, manage, and automate administrative functions such as prior
authorizations and billing.
NOTABLE TECHNOLOGY TRENDSAND PARTNERSHIPS
Center for Connected Health Policy and The National Telehealth Policy Resource Center
• Compile policies related to shifting telehealth due to COVID-19
• Summarize covered services for public and private payers
• Communicate to ensure patients and practices are aware of changes
Capital District’s Physicians’ Health Plans and MVP Health Care (New York State)
• Collaborate to offer telemedicine services
• Allow providers to offer both diagnostic and prescription services over the phone for
COVID-19
PlushCare and Everlywell
• Releasing COVID-19 testing kits (with some difficulty finding a supplier for nasal swabs)
• Focusing on healthcare systems with goal to expand to eligible consumers

6. COVID-19 response in oncology will affect
stakeholders in other therapeutic areas
MULTI-STAKEHOLDER COVID-19 TRENDS
COVID-19 TESTING EXPANSION
• Access to serological testing for COVID-19 antibodies may become a priority across
the country
• Identifying recovered patients may help communities return to normal and can help
individuals understand their risk for future COVID-19 infection
ACCESS TO THERAPY
• Conventional therapies may be continued longer due to lack of ICU beds
• In-office dispensing and IDN-owned specialty pharmacy channels may be
compromised by lack of patient mobility
• Opening new distribution channels may be necessary
R&D IMPACT
• Clinical trial enrollment will slow down and impact future drug development and
commercialization
• New products and indications will launch with less data than before
PAYER PERSPECTIVE
• Payers may reduce or eliminate some barriers to access
• Requiring an earlier line of therapy that can no longer be safely delivered will change
sequencing in oncology and other therapeutic areas
• Watch for payers using COVID-19 analytics to track the disease and identify
economic impact on members and society
PHARMA RESPONSE
• Pharmaceutical manufacturers play a critical support role for patients and providers
during this time. Non-promotional communication around support and supply will be
important
• Manufacturers of potential treatments for COVID-19 are donating supply to the US
government
• Taking an open and generous approach by expanding patient support and ensuring
adequate product supply will help patients with cancer and the providers that treat
them feel at ease
The COVID-19 crisis is unprecedented territory for the US healthcare system. Proactive and
bold commitment to patients, especially within oncology, will have lasting effects on health
system operations.

7. Sources
AMERICAN CANCER SOCIETY
American Cancer Society. Getting oral or topical chemotherapy.
https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/chemotherapy/oral-
chemotherapy.html. Updated November 22, 2019. Accessed March 23, 2020.
AMERICAN SOCIETY OF CLINICAL ONCOLOGY
American Society of Clinical Oncology. CMS announces new changes to respond to coronavirus: what you
need to know. https://www.asco.org/practice-policy/policy-issues-statements/asco-in-action/cms-
announces-new-changes-respond Published March 9, 2020. Accessed March 23, 2020.
ASC Association
Healio. ASC Association provides guidance on necessary surgeries during COVID-19 pandemic.
https://www.healio.com/orthopedics/business-of-orthopedics/news/online/%7Ba9d11f8a-b51d-4831-909f-
8e0f2ac83136%7D/asc-association-provides-guidance-on-necessary-surgeries-during-covid-19-pandemic.
Published March 19, 2020. Accessed March 23, 2020.
ASCO
American Society of Clinical Oncology. ASCO coronavirus resources. https://www.asco.org/asco-
coronavirus-information/care-individuals-cancer-during-covid-19%20f. Accessed March 23, 2020.
CANCER TREATMENT CENTERS OF AMERICA
Cancer Treatment Centers of America to Help Ease Pressure on Community Hospitals In Wake of COVID-19.
http://www.ptcommunity.com/wire/cancer-treatment-centers-america-help-ease-pressure-community-
hospitals-wake-covid-19. Published March 19, 2020. Accessed March 23, 2020.
CMS/FDA
Lagasse J. CMS issues recommendations on adult elective surgeries, nonessential procedures during COVID-
19. Healthcare Finance website. c. Published March 19, 2020. Accessed March 23, 2020.
Press release. Coronavirus (COVID-19) Update: FDA provides update on patient access to certain REMS
drugs during COVID-19 public health emergency. https://www.fda.gov/news-events/press-
announcements/coronavirus-covid-19-update-fda-provides-update-patient-access-certain-rems-drugs-
during-covid-19. Updated March 24, 2020. Accessed March 24, 2020.
JNCCN
Ueda, M. Managing Cancer Care During the COVID-19 Pandemic: Agility and Collaboration Toward a
Common Goal. https://jnccn.org/view/journals/jnccn/aop/article-10.6004-jnccn.2020.7560/article-10.6004-
jnccn.2020.7560.xml. Updated March 20, 2020. Accessed March 23, 2020.
MAYO CLINIC
Mayo Clinic. Specific questions and answers about COVID-19 for cancer patients.
https://www.mayoclinic.org/patient-visitor-guide/covid-19-faqs/cancer. Updated March 22, 2020. Accessed
March 23, 2020.

8. Sources (continued)
MEDIA
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ADDITIONAL READING
Palakurthy, S. Managing a community medical practice through COVID-19.
https://www.linkedin.com/pulse/managing-community-medical-practice-through-covid-19-syam-
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24, 2020.
Yandell, C. Corona virus and cancer care. Cancertodaymag.org/Pages/cancer-talk/The-Coronavirus-and-
Cancer-Care.aspx#.Xnj20c8U7EM. Updated March 18, 2020. Accessed March 24, 2020.

9. How can we help you
navigate oncology
access during the
COVID-19 pandemic?
Dina Steinfurth
Managing Director
dsteinfurth@valuatehealth.com
M. 781.223.3535
ValuateHealth.com