Sifting Through the Wreckage of 2020: 5 Things Worth Salvaging

H. Jack West, MD


February 08, 2021

Unless you bought stock in Zoom early, 2020 was a dumpster fire of a year that we'll celebrate only for its passing. Along with the ongoing loss of lives from the coronavirus pandemic, from an oncologist's perspective we saw a dramatic decline in cancer screening, new diagnoses, and overall visits that we expect will translate into far more advanced cancers and worse clinical outcomes in the coming years.

But the field of oncology requires a regular celebration of successes where we can get them. In that spirit, I'd like to highlight five ways in which we adapted during 2020 that will be constructive improvements moving forward.

The threat of coronavirus transmission in our clinics forced us to reflect on how best to safely deliver oncology care. Last year demanded that we reconsider which practices were critical and time-sensitive and which practices were pro forma. As one example, it became impossible to continue justifying the inertia and protectionism that have long hobbled our ability to deliver telemedicine effectively. And while telemedicine has its challenges, it is a valuable tool. We now know that the Earth continues to turn on its axis despite this shift, and we have an opportunity to offer telemedicine as a component of medical care alongside standard, in-person clinical visits moving forward.

Clinical trials are among the most inflexible and hyperregulated areas in medicine. They have thus been particularly hard hit during the pandemic. I desperately hope that this pandemic forces a revision of the clinical trial process — one that drags it, kicking and screaming, into the 21st century by integrating telemedicine and remote care options that make trials accessible to far more patients.

The coronavirus pandemic cultivated a truly global research community that shared data and insights around the world in real time. In 2020, retrospective data and trials of varying quality were published at an astonishing pace. This led to justifiable concerns about half-baked conclusions and even misinformation, and also highlighted the ongoing question of how best to balance timeliness with the need for meticulous and critical peer review. But at its best, it led to international collaborations and the cultivation of shared insights within the medical and scientific community.

This culminated in the remarkably fast development of multiple highly active vaccines against the coronavirus. It will undoubtedly take quite a bit of time before we resume any kind of life as we formerly knew it, but it is heartening to see what biomedical research can accomplish. It offers us a glimpse of light at the end of this dark tunnel.

We adapted to virtual conferences and digital education. Throughout the year, professional societies pivoted to virtual meetings; in some cases, like the annual meeting of the American Association for Cancer Research, meeting organizers were forced to pull this off in a matter of weeks.

We discussed trial results from these meetings on social media and in Zoom meetings. And while this wasn't the same thing as being physically together, we still experienced the new data together, even if from our homes or offices.

Virtual meetings demand compromises, but they also confer major benefits. Rather than focus on the ways in which these platforms suffer by comparison to the typical experience, I prefer to focus on the opportunity they afford for people who don't have the time, money, or freedom from personal obligations to travel to these meetings. People from all over the world can participate far more readily, without spending thousands of dollars or being away from family. And while it is a less memorable experience to follow conference proceedings from the same desk and computer we use every day, I personally appreciated no longer feeling forced to make the decision between professional and personal commitments that attending these meetings in person requires.

We should expect that we won't be returning to live meetings, at least the larger ones, any time soon. But like telemedicine, I hope virtual access continues to be offered as a parallel option long beyond the time that we're obligated to pursue it.

Platforms like Twitter became the best and potentially only meaningful way to discuss new developments in the field. Last year, most of the news I gathered — whether it was medical, political, or entertainment — was delivered through Twitter or another social media platform.

At their best, social media platforms cultivate a sense of global community. In the world of cancer, the #OncoAlert network of oncology researchers and educators on Twitter, spearheaded by Gil Morgan, MD, from Skåne University Hospital in Lund, Sweden, has an international following that has grown rapidly and has strived to share important developments and commentary. Other educational platforms, such as podcasts by Vinay Prasad, MD, MPH; Chadi Nabhan, MD, MBA; and myself with co-host Charu Aggarwal, MD, MPH, are reinventing how we exchange ideas. One advantage of having educational presentations done virtually is that they are easily recorded and shared on demand, long after the live event, through platforms like VuMedi.

We have an opportunity to clarify the utility of different screening practices. There was a precipitous drop in cancer screening in 2020, one that may well lead to a significant rise in cases of cancer diagnosed later and at more advanced stages. However, this pandemic-induced "natural experiment" in reducing cancer screening will also provide real-world data to either corroborate or challenge specific screening practices in various populations.

We have an opportunity to glean some value from this experience, and it can help refine our screening practices well into the future.

Overall, 2020 will still go down in our collective minds as a tragic year with little to recommend it; I don't think I could have developed a "top 10" list of favorable developments. Yet we can at least be hopeful that we're due for a much brighter 2021.

H. Jack West, MD, associate clinical professor and executive director of employer services at City of Hope Comprehensive Cancer Center in Duarte, California, regularly comments on lung cancer for Medscape. Dr West serves as web editor for JAMA Oncology, edits and writes several sections on lung cancer for UpToDate, and leads a wide range of continuing education programs and other educational programs, including hosting the audio podcast West Wind.

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