Digitalization in Cancer Control During the COVID-19 Pandemic

The COVID-19 pandemic has dramatically affected the provision of cancer services, both screening and treatment; however, it has opened the door for increased digitalization. With the challenges of COVID-19 came the need for hospitals to redirect resources, time and bed space to coronavirus patients, at the expense of other treatments, including for cancer. Statistics from Public Health Scotland in the United Kingdom, for example, show that, owing to COVID-19-related restrictions, breast cancer diagnosis fell by 19 per cent, bowel cancer by 25 per cent and lung cancer by 9 per cent during the first nine months of the pandemic, compared to 2018 and 2019. This is worrying because a delay in the diagnosis of cancer is associated with a worse outcome.

The COVID-19 pandemic has led to compromises in comprehensive cancer control programmes. However, it has also led to a faster uptake of digital technologies and virtual knowledge sharing— with beneficial results that are expected to outlast the pandemic.

To support cancer centres, and ultimately patients, the IAEA has advanced the digitalization of its cancer and human health programmes. The Human Health Campus is an online educational and resource website which helps health professionals in nuclear medicine, radiology and radiotherapy, and nutrition access the latest and most accurate information for dealing with service changes brought on by COVID-19.

“The acceleration of digitalizing resources during the early phase of the pandemic, through platforms like the Human Health Campus, means we are reaching more people than ever before,” said Katherine Wakeham, Head of the IAEA’s Applied Radiation Biology and Radiotherapy Section. “Online, we are helping to enhance the capabilities of health professionals looking to learn about cancer treatment. While this medium is not new, there is growing acceptance, and eagerness from people to learn online has been accelerated.”

By enhancing virtual learning and support through collaborative initiatives with medical experts, the IAEA is facilitating and streamlining access to educational resources. The IAEA’s Comprehensive e-Learning Platform (CeLP), for example, is an integrated set of disease-specific e-learning tools and modules that include microlearning, multimedia and virtual reality.

Online platforms, such as the Asia-Pacific Radiation Oncology Network (ASPRONET) and Africa Radiation Oncology Network (AFRONET), have been strengthened, and are used to share information and connect peer support radiation oncology departments regionally.

Beyond e-learning and networking, the past two years have also seen a faster uptake of innovative technology and techniques. The use of telemedicine for consulting patients, for tumour board meetings and for treatment planning has greatly expanded, and cloudbased and remote systems now allow effective care to be delivered with fewer on-site personnel requirements and reduced on-site space requirements.

“This whole realm of telehealth is very important,” said Dow Wilson, Chief Executive Officer at Varian Medical Systems. “We have thousands of institutions worldwide delivering cancer care very successfully in the pandemic. One of the things that COVID-19 has done is that it has, in fact, accelerated the adoption of telehealth.”

The IAEA has transitioned to hosting many of its conferences online, enabling wider access to its information. The International Conference on Molecular Imaging and Clinical PET–CT in the Era of Theranostics (IPET-2020), held in November 2020, and the International Conference on Advances in Radiation Oncology (ICARO-3), held in February 2021, each attracted over 3000 attendees.

“IPET-2020 and ICARO-3 are great examples of how, by adapting to the conditions imposed by the COVID-19 pandemic, we can improve cancer care knowledge sharing,” said Wakeham. “While there are definite advantages in having a physical conference for fostering interpersonal connections and in-depth discussions, we have found that virtual conferences can be far more inclusive and attract more attendees from all income backgrounds.”

DIRAC and IMAGINE The Directory of Radiotherapy Centres (DIRAC) is a comprehensive online database of radiotherapy resources. It contains current and historical global data, going as far back as 1959, on radiotherapy centres, teletherapy machines, brachytherapy units, treatment planning systems, and computed tomography systems and simulators.

Continuously updated with voluntarily provided information from organizations, radiotherapy centres and other institutions from over 150 countries, DIRAC data is systematically reviewed by a team of experts at the IAEA and verified to detect inconsistencies and ensure completeness. A powerful tool, DIRAC can be used to assess existing radiotherapy infrastructure, plan new radiation oncology centres, and extract performance and quality indicators related to radiotherapy services. Such analyses are used to advocate for equity in the access to cancer treatment, invest in health care infrastructure, benchmark radiotherapy resources, and support academic research.

DIRAC is also a collaborative tool, providing data analysis information and interactive maps, and its users can view and upload information on individual radiotherapy centres and data summaries for countries, regions and even the entire world. Over the past decade, DIRAC has become an essential tool for global health studies and, as a result, more than 180 papers referring to DIRAC data have been published in peerreviewed journals since 2011.

The IAEA Medical Imaging and Nuclear Medicine Global Resources Database (IMAGINE) is a comprehensive compilation of medical imaging and nuclear medicine resources. With information on infrastructure from over 170 countries and territories, IMAGINE showcases findings in world maps and charts, and can show the degree to which imaging, nuclear medicine technologies and relevant skilled human resources are inequitably distributed around the world.

The IAEA is committed to scientific cooperation and to the transfer of nuclear technologies to countries, and IMAGINE helps provide accurate information on the status of technology, facilities, workforce and educational infrastructure to address countries’ needs.