key: cord-0854320-wzhg8mib
authors: Eary, Janet; Shankar, Lalitha
title: COVID-19 Update from the NCI Cancer Imaging Program
date: 2020-05-08
journal: Radiol Imaging Cancer
DOI: 10.1148/rycan.2020204017
sha: d0e2ac2aed42a1c6f6082ba9ea7b7407e2478d63
doc_id: 854320
cord_uid: wzhg8mib

nan

In the midst of the virus pandemic, the National Cancer Institute (NCI) leadership has communicated to the cancer and research communities that the NCI is operating at 100%, performing all the tasks associated with grant administration and research. The NCI research facilities are applying their significant expertise in virus biology to investigate potential vaccines, therapies, and research aimed at understanding the pathobiology of coronavirus infection and its heterogeneity in expression in different individuals. The NIH and NCI have issued several guidances on how investigators can cope with research and training pauses, as well as shut down facilities, particularly those activities with timelines. The NCI Cancer Imaging Program is utilizing The Cancer Imaging Archive resource to de-identify and publicly host an initial COVID-19 chest (CT and plain film) reference image dataset for health care providers worldwide and researchers interested in pursuing artificial intelligence (AI) approaches for diagnosis and recovery follow-up. Additionally, the NCI along with many other institutes at the NIH have issued supplemental funding announcements for funded investigators who want to direct a part of their research to COVID-19 biology issues. Interested investigators should view institute websites and contact their grants program officers for information. Altogether, the NCI is significantly involved in support of the NIH mission's response to the demands on the scientific community for the coronavirus pandemic response.

Cancer patients and their access to care are a major focus during the pandemic. While the state-of-the-art research and patient care support are always NCI main missions, access to care and special considerations for cancer patients have been addressed this spring. Cancer patients need to have continuity of their active treatment and follow-up and may have special access problems to their providers for their best outcomes. For patients on NCI-sponsored clinical trials, minor violations such as a short delay in a required visit or blood test have been waived to ensure that a patient can remain on clinical treatment trials and receive timely therapy (1). This effort has been coordinated across the National Clinical Trials Network, NCI Cancer Centers, and the NCI Community Oncology Research Program (community cancer centers) and includes video or phone consults in lieu of physical visits for follow up and adverse event management for subjects in ongoing clinical trials. Also, oral medications can be mailed to the patient's home and other conveniences made where possible to enable patients to maintain their therapy. Because cancer patients are at a uniquely high risk for poor outcome from coronavirus infection due to immune compromise, treatment toxicity, and other pathobiological factors, the NCI recently announced the development of a clinical trial to study the natural history of COVID-19 in affected cancer patients. This will include patient diagnosis, history, and several tests for genotyping on blood samples drawn during patient care. This dataset will also include standard of care imaging that patients receive while in treatment. Special attention will be paid to chest imaging, but also areas of disease involvement if symptoms suggest non-chest involvement such as liver, renal, and neural tissues, especially brain. This dataset will be useful for research aimed at understanding the pathobiology of the coronavirus in cancer patients, as well as insights into different populations who are displaying variable I n p r e s s risks to infection and poor recovery outcomes. The data will also be analyzed to assess if complication rates are cancer-type dependent.

There is currently a great deal being written from all sectors of society on how we are coping with social distancing, quarantine, travel restrictions and reductions in different areas of business. This, of course, is combined with the huge demands on the health care access, financing, and support across the nation. At the same time, many are opining about "life after social distancing" or "the new normal" and what these might be. From our perspective, the NIH research administration has been equipped to carry out its functions and missions during demands for telework and social distancing. This set of professional practices has been a huge success so far, demonstrating the dedication of the NIH community to fulfilling its mission for national support for biomedical research. What have we learned? Like many professional sectors, we are finding that we can utilize much more fully the outstanding online support and tools that have been at our fingertips, but only occasionally utilized until now. Even then, they are probably not being utilized to their fullest extent for workplace productivity. In our time of extended telework, we are finding that even the least cyber savvy amongst us is able to participate in a video meeting, attend small and large national meetings, deliver presentations, participate in conferences, and work jointly on documents generation and editing. We are paying attention to our personal device monitoring cues to get up move around, change eye focal distance, consume fluids, and all the other activities we may normally ignore while at work in the office. We also are taking heed of suggestions to go outside for a walk to get some fresh air now with much more commitment than previously.

For the research community, as we continue to understand that communication with each other is vital for innovation, productivity, and learning, we are learning new ways of meaningful communication. If anything, we understand the importance of maintaining good communication more than ever. We are also realizing news ways of gaining and exchanging information. In these experiences, we have opportunities to identify new gaps in areas where we need improvement in communication, collaboration and in scientific research areas. For scientific pursuits, these include the importance of image and metadata sharing platforms as well as the amount of data required for AI-hypothesis driven approaches to pathobiological problems. With the infrastructure that we already have in place and are rapidly developing, we can take advantage of these advances to pose provocative scientific questions. In other words, we need to make the most of our infrastructure and personnel investment in our research communities. One of the things we are learning about ourselves in biomedical research and patient care during the pandemic is the value of interpersonal interactions, at work, at large meetings, and in our respective communities. For the world of clinical trials, continuing the options of obtaining informed consent via telephone or video calls, follow up visits with video calls, and similar conveniences can potentially increase participation in studies. In addition, if radiology and nuclear medicine clinics in community settings can be engaged to undergo qualification of imaging devices, there could be a significantly broader network of available sites participating in clinical trials where imaging is a primary or secondary objective. For the future we can continue to realize the value of these interactions and plan the use of our finite resources accordingly knowing that we can accomplish much with technology. In doing so, we will be able to heighten our focus on harnessing AI approaches and other data-based interventions to continue to make advances in promoting health across all our constituencies.

Department of Heath & Human Services memorandum