Billionaire Eric Lefkofsky’s Tempus Raises $200 Million To Bring Personalized Medicine To New Diseases

On the surface, Eric Lefkofsky’s Tempus sounds much like every other AI-powered personalized medicine company. “We try to infuse as much data and technology as we can into the diagnosis itself,” Lefkofsky says, which could be said by the founder of any number of new healthcare companies.. But what makes Tempus different is that it is quickly branching out, moving from a focus on cancer to additional programs including mental health, infectious diseases, cardiology and soon diabetes. “We’re focused on those disease areas that are the most deadly,” Lefkofsky says. 

Now, the billionaire founder has an additional $200 million to reach that goal. The Chicago-based company announced the series G-2 round on Thursday, which includes a massive valuation of $8.1 billion. Lefkofsky, the founder of multiple companies including Groupon, also saw his net worth rise from the financing, from an estimated $3.2 billion to an estimated $4.2 billion.

Tempus is “trying to disrupt a very large industry that is very complex,” Lefkofsky says, “we’ve known it was going to cost a lot of money to see our business model to fruition.” 

In addition to investors Baillie Gifford, Franklin Templeton, Novo Holdings, and funds managed by T. Rowe Price, Lefkofsky, who has invested about $100 million of his own money into the company since inception, also contributed an undisclosed amount to the round. Google also participated as an investor, and Tempus says it will now store its deidentified patient data on Google Cloud. 

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“We are particularly attracted to companies that aim to solve fundamental and complex challenges within life sciences,” says Robert Ghenchev, a senior partner at Novo Holdings. “Tempus is, in many respects, the poster child for the kind of companies we like to support.” 

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Tempus, founded by Lefkofsky in 2015, is one of a new breed of personalized cancer diagnostic companies like Foundation Medicine and Guardant Health. The company’s main source of revenue comes from sequencing the genome of cancer patients’ tumors in order to help doctors decide which treatments would be most effective. “We generate a lot of molecular data about you as a patient,” Lefkofsky says. He estimates that Tempus has the data of about 1 in 3 cancer patients in the United States. 

But billing insurance companies for sequencing isn’t the only way the company makes money. Tempus also offers a service that matches eligible patients to clinical trials, and it licenses  de-identified patient data to other players in the oncology industry. That patient data, which includes images and clinical information, is “super important and valuable,” says Lefkofsky, who adds that such data sharing only occurs if patients consent. 

At first glance, precision oncology seems like a crowded market, but analysts say there is still plenty of room for companies to grow. “We’re just getting started in this market,” says Puneet Souda, a senior research analyst at SVB Leerink, “[and] what comes next is even larger.” Souda estimates that as the personalized oncology market expands from diagnostics to screening, another $30 billion or more will be available for companies to snatch up. And Tempus is already thinking ahead by moving into new therapeutic areas. 

While it’s not leaving cancer behind, Tempus has branched into other areas of precision medicine over the last year, including cardiology and mental health. The company now offers a service for psychiatrists to use a patient’s genetic information to determine the best treatments for major depressive disorder. 

In May, Lefkofsky also pushed the company to use its expertise to fight the coronavirus pandemic. The company now offers PCR tests for Covid-19, and has run over 1 million so far. The company also sequences other respiratory pathogens, such as the flu and soon pneumonia. As with cancer, Tempus will continue to make patient data accessible for others in the field— for a price. “Because we have one of the largest repositories of data in the world,” says Lefkofsky, “[it is imperative] that we make it available to anyone.” 

Lefkofsky plans to use capital from the latest funding round to continue Tempus’ expansion and grow its team. The company has hired about 700 since the start of the pandemic, he says, and currently has about 1,800 employees. He wouldn’t comment on exact figures, but while the company is not yet profitable he says Tempus has reached “significant scale in terms of revenue.” 

And why is he so sure that his company’s massive valuation isn’t over-inflated? “We benefit from two really exciting financial sector trends,” he says: complex genomic profiling and AI-driven health data. Right now, Lefkofsky estimates, about one-third of cancer patients have their tumors sequenced in three years. Soon, he says, that number will increase to two-thirds of patients getting their tumors sequenced multiple times a year. “The space itself is very exciting,” he says, “we think it will grow dramatically.” Follow me on Twitter. Send me a secure tip

Leah Rosenbaum

Leah Rosenbaum

I am the assistant editor of healthcare and science at Forbes. I graduated from UC Berkeley with a Master’s of Journalism and a Master’s of Public Health, with a specialty in infectious disease. Before that, I was at Johns Hopkins University where I double-majored in writing and public health. I’ve written articles for STAT, Vice, Science News, HealthNewsReview and other publications. At Forbes, I cover all aspects of health, from disease outbreaks to biotech startups.

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Eric Lefkofsky

To impact the nearly 1.7 million Americans who will be newly diagnosed with cancer this year, Eric Lefkofsky, co-founder and CEO of Tempus, discusses with Matter CEO Steven Collens how he is applying his disruptive-technology expertise to create an operating system to battle cancer. (November 29, 2016)

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Online Therapy, Booming During the Coronavirus Pandemic, May Be Here to Stay

Mental health flows from the ceramic jug psychotherapist Lori Gottlieb keeps on her desk. There’s nothing special about the jug—a minor accessory in an office designed with the sort of tidy impersonality common to her field. And there’s no special elixir in it—just water. But all the same, the jug provides a certain kind of healing. When patients are struggling, crying, overcome in some way, Gottlieb, a Los Angeles based practitioner and author of the book Maybe You Should Talk to someone, will offer up a cup of water, pour it for them and hand it across.

In that small gesture is a whole constellation of meaning: concern, care, protectiveness, generosity. It’s a little grace note that’s possible only in person—only when two people are in the same room, sharing the same space, face to face across just a small physical gap. Ever since March, however, when much of the U.S. went into lockdown as a result of the COVID-19 pandemic, such in-office intimacy became impossible across nearly all professional disciplines. Psychotherapy sessions—like so very much else—have become virtual, conducted on-screen, at a remove, riding the electrons of Zoom or Skype or Google Meet. And that comes at a price.

“There’s the ritual of coming in every week, sitting in that room on the same spot on the same couch in the same office,” says Gottlieb. “It feels incredibly comforting and safe. I think the environment part of it is very important for people.”

That’s not true just of mental health, of course. Most of us aren’t getting a fraction of the person-to-person interaction we’re accustomed to, and most of us are pretty well fed up with it. Virtual birthday parties are no party at all. Virtual happy hours have everything but the happy. Call it Zoom fatigue, cabin fever, flat-out loneliness—many today are suffering from isolation to one degree or another and long for the moment that the virtual lives we’ve been forced to live can be tossed aside.

But telepsychology (or telepsychiatry or tele-mental-health, as it’s been variously called) may have a stickiness to it that other aspects of virtual living lack. In recent years there’s been more and more talk in the health care professions about the potential for telemedicine. For some kinds of care, it’s easy to see how routine “office visits” that allow doctors and patients to meet without the need for an actual office could work: the orthopedic surgeon checking a patient’s range of motion and inquiring about pain after knee replacement surgery, say. But too many other visits require hands-on contact—palpating, blood draws, suturing—to make telehealth a universal practice.

Tele-psych, though—with its talk-and-listen simplicity—is a different matter. If ever there was a caring discipline that was poised to jump aboard the telemedicine train, it’s mental health.

“In February of 2020, before COVID-19 really hit our country, telepsychiatry was beginning to be widely available but only sporadically adopted,” says Dr. Jay Shore, a professor at the University of Colorado Anschutz Medical Campus and the chair of the American Psychiatric Association’s Telepsychiatry Committee. “Now it’s been a tsunami. At the University of Colorado maybe 10% to 20% of [mental health] visits were over video before. Now, outside of inpatient stuff, we’re at like 100%.”

That has been true pretty much everywhere else in the country, where therapy sessions have been happening either online or not at all. In mid-May, the American Psychiatric Association surveyed its members on how frequently they held tele-psych sessions both before and after the onset of the pandemic. The results were striking: Prior to COVID-19, 63.6% of respondents did not use virtual sessions at all. After the onset of the pandemic that figure plunged to just 1.9%. Conversely, before COVID-19 hit, only 2.1% reported using tele-psych 76-100% of the time. During the pandemic that figure has soared to 84.7%.

It was a change made by necessity, not by choice, but there are plenty of people who like what they’re experiencing. There’s convenience for one thing: a 50-minute session is a 50-minute session, not two or three times that as the patient wastes part of the day just getting to and from the appointment. That’s especially important in rural communities that might have been mental health deserts before—with the nearest caregivers requiring a long drive to the closest big city.

Patients are able to have their appointments pretty much anywhere. “If you were going to go drop your kids off at soccer practice, you could sit in the car and have a relatively private session with your therapist while you’re waiting for the soccer match to be over,” says psychologist Jared Skillings, chief of professional practice for the American Psychological Association. “This provides a significant increase in access and quality of life.”

Tele-psych also allows for more enduring doctor-patient relationships. If your job transfers you to another city, you can always find another doctor to tend to your physical ills, but you didn’t spend years confiding your most intimate secrets to your cardiologist or ophthalmologist and now have to start over with an entirely different person. Your psychologist is another matter entirely. “The advantage is clearly that you get to have continuity of care,” says Gottlieb.

All of those plusses have some in the community convinced that not only are tele-sessions the future of mental health, but that that future is now. “I think that anyone who tries to prognosticate comes across as a fool,” says Shore. “But what I can say is that we will never be the same, we won’t go back to where we were.”

And yet, what about that water jug? What about the sense that a therapist’s office is a third place, a safe space, neither work nor home but a place that, for those 50 minutes at least, feels like the patient’s own? Not every patient is the same and for many there is a comforting ritual in the opening of the doctor’s door and the gathering in that follows. Shore may indeed be right that the forced experiment with tele-psych that the quarantine months have necessitated has dramatically changed the game. Just how much and how enduringly it’s been changed is the real question.

Teletherapy may seem very much of the moment, but it’s not a new idea. As long ago as 1959, the University of Nebraska began a pilot project using mid-century video technology to allow patients and doctors to meet remotely. But the system was expensive and impractical and it lent itself poorly to the Freudian era of lying on couches and free-associating to a silent therapist whose face you didn’t even see. It wasn’t until the late 1990s, with the Internet fully entrenched and two-way video platforms coming online that the telehealth gained any traction. Even then though, it was used in a limited way.

“We started to see big systems like the Department of Defense and the Veteran’s Administration and jails develop sustainable larger scale telepsychology services to serve their populations,” Shore says.

Still, that was enough to prove the technology’s potential—if not its immediate appeal—and practitioners adopted it unevenly. While Shore reports that well before the pandemic he already had patients he’d worked with for 12 to 15 years and had never met in person, Gottlieb wanted no part—or at least very little part—of telehealth.

“I didn’t do telehealth at all unless there was a circumstance like I already had an established patient and that person was going to be on a work assignment for a few months,” she says. “But I would never meet somebody doing telehealth.”

Then the pandemic forced the profession’s hand and even doubters like Gottlieb have seen some of its advantages. She concedes that she likes the leveling effect of both patient and doctor getting background glimpses into each other’s homes—a sort of intimate equality of behind-the-scenes access. She likes the insight she gets when a patient Zooms from a bedroom and she catches sight of what’s on the nightstand.

“Usually what people keep on their nightstand tends to be the most personal of things, what means the most to them,” she says.

And she likes, too, the spontaneity and humor that a tele-session can provide. A surprising number of people, Gottlieb says, will have a session in the bathroom, sitting on a closed toilet—looking for a private spot in their homes. During one session, a patient was crying because her mother was in a nursing home where COVID-19 had been detected, and she was worried. She sat back and accidentally hit the handle of the toilet causing it to flush loudly.

“She was embarrassed and said, ‘Am I the only person who does therapy from the toilet?’ And I said, ‘No, actually the toilet has become the new couch.’” They both laughed—which the patient later said was the best and most helpful moment in the session.

Whether all sessions will be so effective depends at least in part on the kinds of issues the patient is struggling with. Obsessive-compulsive disorder, for example, lends itself comparatively well to tele-psych sessions because the standard of care for it is what’s known as skill-based therapy—learning behavioral tools that help break the OCD cycle—which may require less intimacy than other kinds of therapy, and instead calls for rigorous practice and discipline. Post-traumatic stress disorder patients may similarly benefit from online therapy, at least at first, since the home might feel like a safer space than a doctor’s office.

But there are downsides in treating these and other disorders online—in the form of cues missed due to the limited frame of a computer screen. The jiggling foot, the knotted hands, the subtle shifting in the chair that telegraphs unease with a topic of conversation are all lost to the doctor in tele-sessions. For patients battling substance abuse it’s hard to get away with the telltale gait of intoxication or the smell of alcohol on the breath in an in-person session. Not so hard on Zoom.

Group therapy can present its own challenges. A key part of the dynamic of the group involves eye contact—who’s listening, who’s not, who’s offering an affirming nod or shifting uncomfortably at someone else’s story that may hit a raw nerve in the listener. On a Zoom screen with a dozen faces arranged in Brady Bunch tiles, all of that is missing.

Even when the group is just two people, things get lost. Gottlieb recalls counseling a couple in a telehealth session and suddenly noticing their mood going from comparatively detached to warm and compassionate. “I was trying to figure out what had shifted there and then one of them said they were holding hands,” she says. “But I didn’t see it. They were holding hands under where I could see.”

If tele-psych is going to have a wide, post-pandemic future, it depends on more than just the acceptance of patients and providers. As with so much else in the U.S. health-care system, things come down to who will pay. During the pandemic, Medicare, many state Medicaid programs and commercial insurers have loosened rules or allowed waivers to cover telehealth sessions. When the pandemic ends, however, so could the payments.

Those in the field want to stop that from happening, making sure we don’t lose the lessons we’ve learned from the experience. “We are advocating for Medicaid, Medicare, and private payers to keep telehealth turned on at least for 12 more months after the coronavirus pandemic is officially declared to be over so that we can better evaluate the impact that has had on patients,” says Skillings.

In a live June 9 event with STAT News, Seema Verma, the Administrator for the Centers for Medicare and Medicaid Services (CMS), offered support for that kind of sentiment, arguing that coverage for most forms of telemedicine, including tele-psych, should indeed continue after the pandemic ends. The dramatic increase in overall access to care—with telemedicine visits increasing 40-fold in some parts of the country during the pandemic—is, all by itself, an argument for maintaining the system, she said. In August, the CMS issued new guidelines that provide physicians nine new billing codes to cover telemedicine going forward.

The portability issue is another unsettled question that will endure beyond the pandemic. It’s true that one of the advantages of tele-psych is that patients who move from state to state can continue to work with their original doctor—but that’s only if each state’s licensing rules permit that kind of cross-border practice, and so far most don’t.

In 2011, the Association of State and Provincial Psychology Boards—one of the profession’s governing bodies—created a task force to promulgate tele-psych guidelines for practitioners. From that came a proposal for what became known as PSYPACT, a national reciprocity system under which states would accord tele-psych privileges to practitioners living in other states. Joining the group requires action by state legislatures, and currently 15 have passed the necessary laws, with approval pending in 12 more states and the District of Columbia.

“At the end of the day,” says Skillings, a vocal PSYPACT advocate, “this is actually about providing care to our community, to improve their health.”

Improving community health is, of course, what all medicine, virtual or otherwise, is about. Mental health, which lacks the clarity of other medical disciplines—the blood tests and CT scans and MRIs that can make diagnosing illnesses and prescribing treatments so straightforward—has always needed more options in its therapeutic toolkit. Tele-psych, even with its doubters and its drawbacks, is easily one of the newest. In time, it may also prove to be one of the best.

By Jeffrey Kluger

The Coronavirus Killed the Handshake and the Hug. What Will Replace Them?

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Dr. Mark Sklansky has always hated shaking hands. He can think of about a dozen better ways to greet patients than the icky exchange. “Hands are warm, they’re wet, and we know that they transmit disease very well,” says Sklansky, chief of pediatric cardiology at UCLA Mattel Children’s Hospital. “They’re a phenomenal vector for disease.” He’s also tried to avoid this form of greeting because he knows that some patients don’t want to shake hands for religious or cultural reasons but feel compelled to when their doctor sticks out a hand.

For a long time, though, being anti-handshake was fringe thinking. The handshake is such an ingrained part of the doctor-patient relationship that it happens 83% of the time, according to one 2007 analysis of more than 100 videotaped office visits. Sklansky was once nervous to take a stand against the popular gesture. “I honestly didn’t want to admit this to anyone for the longest time,” he says. But in a 2014 paper, Sklansky and his colleagues argued that shaking hands in health care settings can spread pathogens and viruses, and that health care workers can help keep patients safe by keeping their hands to themselves.

The blowback was swift. Physicians huffed that getting rid of the handshake would erode the already fragile doctor-patient bond, that the greeting was irreplaceable, and that they could manage to shake hands and wash them without spreading disease, thank you very much. “A lot of people laughed at the idea,” Sklansky says. “But now, people aren’t laughing.”

Handshakes are just one form of touch that has evaporated during the global coronavirus outbreak. So have hugs, high fives, fist bumps, back pats, shoulder squeezes and all of the little points of contact we make when we stand closer than six feet apart. And as Americans emerge from their homes and inch closer together to rebuild their social lives, experts are betting that some degree of social touch will disappear permanently, even after the pandemic ends. “I don’t think we should ever shake hands ever again, to be honest with you,” said Dr. Anthony Fauci in an April interview with the Wall Street Journal podcast.

If social touch disappears more than just temporarily, there’s no consensus on what will replace it. But one thing is little disputed: Social interactions are about to start feeling really weird. “As we come out of quarantine and isolation, I think we’re going to see some people offering handshakes and some people not wanting to touch them with a 10-foot pole,” says Aaron Smith, a psychotherapist and instructor in the school of social work at Renison University College in Canada who explored the pluses and pitfalls of handshakes in a journal article published in March. “There’s going to be a lot of awkwardness as people try to figure out how to greet somebody, how to professionally welcome somebody, how to meet your daughter’s boyfriend for the first time.”

This uncertainty can affect those relationships. “We’re going to start seeing a lot more interpersonal and family-based sorts of conflict,” Smith predicts. If a business colleague attempts a handshake or your mom goes in for the hug, and you pull away, “there’s going to be some pretty big ripple effects in terms of the relational dynamics that we see.”

Why we touch

Even if you hate being hugged outside of intimate relationships or despise shaking hands, losing social touch completely—as we have during COVID-19—still may not feel normal. “Suddenly, we’re starting to realize all of these touches that are missing,” says Juulia Suvilehto, a researcher at Linköping University in Sweden who studies social bonds. “It feels like there’s this weird gap.”

Touching acquaintances and strangers serves an evolutionary purpose. Language is the most obvious way that humans foster social ties with one another, but touch does something similar. “We know that nonhuman primates use social touch a lot through grooming,” Suvilehto says. “The larger the group, the more time they spend on it. It’s a way of making allies and maintaining relationships.”

Touch also helps reduce aggression between people, says Tiffany Field, director of the Touch Research Institute at the University of Miami School of Medicine. “When you’re socially touching someone, it’s very hard to be aggressive towards them.” Conversely, “if you separate two monkeys and they can see, hear and smell each other, but they can’t touch each other, once you remove the plexiglass, they practically kill each other.”

Over her career, Field says she has watched touch fall off so sharply in American society that she thinks she’ll have to find something else to study. Social hugging was largely sidelined by the Me Too movement, and smartphones took care of the rest. About a year ago, she and her students observed people as they sat at airport departure gates and recorded how often they touched one another. She expected to see people holding hands with their intimate travel companions and slinging their arms around each other. “We weren’t seeing any touching, even between couples and families who were traveling together,” Field says. “Everyone was on cell phones…just scrolling and texting and gaming.”

Field doesn’t think touch will bounce back socially—she suspects the elbow bump will edge out the handshake—but she’s hoping that touch is returning among families who are spending more time together in quarantine. Welcome touch is good for your health; it’s been shown to lower stress and activate the release of oxytocin, which is nicknamed the “love hormone” and helps promote bonding and closeness.

Nice to meet you?

Shaking hands is probably the most common form of social touch in the U.S., and it’s thought to have originated many centuries ago as assurance that neither party was carrying a weapon. “It signals trust and cooperation,” says Sanda Dolcos, who runs a neuroscience research lab at the University of Illinois with her husband, Florin Dolcos. In the team’s neuroimaging studies, “you can really see in the brain that areas that are involved in processing rewards are activated when people are shaking hands,” Sanda says. Even watching people shake hands is enough to increase activation in the brain’s reward centers, their research has shown.

“The expectations that come in terms of social or physical interactions are so hardwired,” Florin says, that he doesn’t expect the handshake to permanently disappear after the pandemic is under control. Neither does Smith. “I would be stunned if a year from now, it was gone,” Smith says. “I would be absolutely shocked because of how commonplace and universal it is. I don’t see it going away overnight.”

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But even they believe that it will change. People might reserve handshakes and hugs for those who are closest to them and who they trust the most and develop new greetings that don’t involve skin-on-skin contact for those further outside their social circle. There are many alternatives: the elbow bump, a foot tap, a bow, the namaste gesture, a brief nod or head tilt, placing a hand on your heart. It’s unclear which of these will prevail, if any. “You see such a wide range of values and beliefs and political views about all of this stuff,” Smith says. “Underlying all of those are layer upon layer of professional and personal beliefs and values stemming from our childhood, from our religious orientation, from the messages we’ve been taught in school.” We won’t all arrive at the same solution.

But research has shown it is possible—to some degree—to embrace touch-free alternatives. Sklansky, the pediatric cardiologist and anti-handshake crusader, conducted an experiment to see if he could eradicate the handshake in two of UCLA’s neonatal intensive care units, where some of the most vulnerable patients are treated. In a 2017 study, he describes setting up handshake-free zones by posting signs depicting two clasping hands, crossed-out, and encouraging the doctors, nurses and residents to try different nonverbal greetings. While about a third of providers were resistant—especially physicians, and especially men—nearly all of the patient families were in favor of not being touched by their doctor. Fewer than 10% said they wanted to be greeted with a handshake. The vast majority preferred instead when health care providers looked them in the eye, smiled, addressed them by name or asked about their wellbeing.

The handshake has long been a way for doctors to quickly establish rapport with their patients, but something contactless is now necessary—not only because of the pandemic, but also because of the rise of telemedicine. “We’re not going to have some sort of digital handshake,” says Gregory Makoul, founder and CEO of PatientWisdom, a company that helps health organizations improve patient engagement and communication. Makoul co-authored the 2007 study about how prevalent handshakes are in health care, but he believes that words can also build a bond. “You need to have the kind of conversation that makes that connection.”

The future of social touch is here

If you feel that personal connections are harder to form when talking to someone six feet away or through a screen on Zoom, you’re not alone. “You’re having to verbalize a lot more things that you would normally express with touch,” Suvilehto says. Hugging someone who needs comforting or placing a hand on their shoulder often feels easier and more natural than finding the right words.

Being forced to voice these feelings might turn us into better communicators. “But the other option is that people will just stop communicating about emotions,” Suvilehto says.

Just as social touch can be a substitute for language, you may have to over-communicate with words the feelings you would once get across through physical contact. Welcome to Sklansky’s world, who’s been taking the long, verbose way around the handshake for years. “When people reach out, I just say, ‘Listen, I’d rather not shake hands. I don’t think it’s a good idea for different reasons.’ I explain why, and I talk about the paper,” he says. He opts instead for the namaste gesture. “People smile and think it’s sort of funny,” he says. “But I think it’s something that over time, people could get used to here.”

By Mandy Oaklander

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As COVID-19 is at risk of moving towards community transmission, it’s time for all of us to take social distancing right now. Health officials desperately trying to slow the spread of the Covid-19 coronavirus outbreak and are pleading with each other to practice social distancing and good hygiene.

Collateral Damage Of Covid-19: More Than 200 International Cancer Trials Suspended

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As we continue to treat and discharge patients with Covid-19 from hospitals throughout the US, we are acutely aware of patients avoiding the ER for fear of contracting Covid-19.Messaging that reflects not only the safety but necessity of seeking care in the setting of life threatening conditions is vitally important to assure the health of the American people.

Deaths from heart attacks, strokes and sepsis, reflected in data measuring excess mortality—deaths beyond what we would have solely expected from Covid-19—remind us of the “other” casualties of the pandemic.But other types of casualties from the pandemic include cancer patients, many of whom have not been able to receive necessary surgeries or treatment during the height of the lockdown, along with those who may have not been able to be enrolled in trials using investigational approaches and novel therapies.

“The battle against cancer is formidable even in normal circumstances; Covid-19 adds to this battle by not only predisposing this population to higher morbidity and mortality but has also forced the majority of the cancer institutions in the U.S. to shut down the clinical trials in cancer patients to deal with the present crisis”, said Wasif M. Saif, M.D., Deputy Physician-in-Chief and Medical Director, Northwell Health Cancer Institute, Lake Success, New York,

“I call the Covid-19 pandemic and cancer situation a “two-front war“. The first fight is with cancer — a disease that claims 600,000 lives each year in the U.S. Data from published studies during this pandemic clearly suggests cancer was associated with an increased risk of death of patients three times higher than those without cancer, and also increased intensive care unit admission and ventilation support,” added Saif.

With these issues in mind, there is no doubt that efforts to conduct medical research in just about every discipline has been significantly affected by the pandemic. Certainly, oncology is one area where ongoing research is vital to impacting patient mortality and decisions regarding cutting edge treatments.

In fact, based on findings of a recent study, more than 200 international cancer trials have been suspended as a result of disruption of normal clinical operations globally from Covid-19. The effects were most apparent in the US and in Europe, but also in Asia to some degree, based on the results of the study. The effects of this disruption will likely be incalculable in terms of progress and mortality data that we may see both in the near and long term.

Researchers analyzed data from ClinicalTrials.gov looking specifically at patient enrollment during the critical early months of the pandemic. They used a survey to understand the effects on 36 investigators (between March 23 to April 3) conducting cancer- related clinical trials at various institutions across multiple countries. A separate analysis by a health care data analytics firm, IQVIA, also looked at the factors affecting more than 200 ongoing clinical trials.

Results of the survey demonstrated that 60% of institutions in the US and 86% in Europe are enrolling now enrolling patients at a reduced rate compared to prior to the pandemic. The main factors affecting enrollment, based on survey data, included lack of access to patients themselves during the lockdown, investigator concern related to patient safety, lack of research staff, along with mode of cancer treatment and type of cancer.

At the time of the survey in March to early April of 2020, it was noted that patient enrollment in clinical trials had precipitously declined, particularly in the US and in Europe. In fact, only 20% of institutions in the US and 14 % in Europe resumed enrollment at their pre-pandemic rate. Meanwhile, about 60% of the enrollments in Asia had not changed.

If you look at institutions that continued to conduct trials with reduced enrollment rates, 23% cited patient care and type of cancer therapy encompassing the route of administration, as two of the main considerations adversely affecting patient enrollment. Additional concerns included lack of research or support staff, resources, and well as patient safety. Aside from this, risk vs. benefit was the primary consideration for patients being enrolled in ongoing trials.

Similar trends were also observed in the case of initiating new trials with patient care, type of cancer therapy, and route of administration being the main considerations. Researchers also expressed concern about therapy that required IV administration compared with oral approaches, since oral medications could be taken in the home setting.

In evaluating regulatory and operational challenges related to Covid-19 patients overwhelming healthcare systems, nearly 60% of researchers said that Covid-19 had moderate or high impact leading to delayed or cancelled patient visits, and close to 80% of researchers believed that such protocol irregularities would lead to incomplete records and research.

“The biggest delayed consequence of the COVID-19 pandemic would probably be in delaying cancer drug development, with its own consequences both for the cancer patients as well as for the pharmaceutical industry,” said Saif. Beyond this, financial considerations also come into play in any calculation regarding the toll of the pandemic on cancer clinical trials.

“Sites have to bear the brunt of an ever-changing clinical landscape while tackling potential loss of revenue,” explained Saif. “In clinical research, a major portion of site revenue comes from industry sponsored trials. Payments to sites are based on enrollment, patient visits completed and timely data entry. In many sites, enrollment to studies had to be limited to ensure patient and staff safety.  Concern for safety has also led to the cancellation of many non-essential study procedures. Less recruitment and more cancellations mean less revenue sites will receive.”

The use of alternative technologies to reduce the need for in-person visits for research and evaluation was crucial during the pandemic. Such approaches included telemedicine, but also virtual monitoring of data and study documentation, as well as remote electronic health record access for those conducting patient evaluation and follow-up. Directly shipping drugs to patients as well as avoidance of specific immunosuppressive regimens also constituted ways that researchers altered their approaches to conducting research.

“The Covid-19 pandemic gave all of us a crash course of telehealth and provided a new tool to interact and manage cancer patients,” offered Saif. “But it is important to remember that this is a population who was previously reluctant to digital communication—even in a blizzard, I remember having 80% patients showing up.”

Saif further said that “Telehealth can help us to interview but misses the human touch, and most importantly physical examination which in some cases is crucial including measurement of a tumor mass or others.”On the upside, Saif stressed that” it [telehealth] can offer a platform to manage immunocompromised patients and carries the potential to see second-opinions in a quick manner allowing us to save resources at the same time.”

Data from ClinicalTrials.gov noted that more than 200 interventional oncology trials were suspended during the months of March and April—62 suspended during March and 139 suspended during April. Looking at the breakdown of suspended trials, 29 were phase 1, 72 phase II, 11 phase III, with the remainder classified as “other”.

Saif sums it up simply: “ The Covid-19 pandemic has changed the way we treat cancer and perform cancer trials; first and foremost, we need to carve out a long-term plan to care for our patients in anticipation of another wave of COVID-19 now or in Fall.”

“We not only need to resume the clinical research but gain acceleration urgently to move on with development of cancer drugs simultaneously with treatments for Covid-19,” he offered. “But don’t forget the human factor, “the fear” by the patients and their families to return to cancer centers – we need to reassure that we are a safe facility. This pandemic has forced us to culminate a rationalization basis for cancer services, both diagnostic and therapeutic. Not only institutions were required to develop guidelines under multidisciplinary teams, but many national and governmental organizations also laid out guidelines about who and how to treat.”

“This pandemic not only stretched health systems in terms of constraints related to workforce of health care providers due to their own illness or family members but also threatened to exhaust the assets, including capacity of hospital beds, ventilators, PPE introduced by the financial impact of COVID-19. It is hoped that the effect of this rationalization in cancer care will last long and allow us to analyze and fix the issues of health disparity, such as access to cancer services, socioeconomic and ethnic differences,” concluded Saif.

Going forward, it will be vital to mitigate the impact of future shutdowns on ongoing cancer trials, not to mention basic cancer care and surgeries. This will help to guide us in the future with a clear plan when the next pandemic strikes.

“The current paradigm for clinical trials in the U.S. requires both patient and researcher to be in direct contact with one another—a patient enrolled in a clinical trial receives the cancer care prescribed by the trial at the hospital the researcher is at,” said Miriam A. Knoll, M.D., DABR, a radiation oncologist, and a Forbes healthcare contributor, “With the advent of expanded telehealth coverage across the U.S. due to COVID-19, researchers have an unprecedented opportunity to expand access to clinical trials.”

“The next major hurdle will be how quick the regulatory oversight of trials can be adapted to these new researcher-volunteer relationships, to ensure optimal care, safety, and research integrity,” Knoll added.

Follow me on Twitter. Check out my website.

I am an emergency physician on staff at Lenox Hill Hospital in New York City, where I have practiced for the past 15 years. I also serve as an adviser and editor to Medscape Emergency Medicine, an educational portal for physicians, and an affiliate of WebMD. My other time is spent with my private house call practice, DR 911, providing medical care to both travelers and residents in Manhattan. I have a keen interest in medical technology and public health education.

Source: https://forbes.com

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Dr. Cardinale B. Smith, Chief Quality Officer for Cancer, shares information cancer patients need to know regarding COVID-19.

9 Future Predictions For A Post-Coronavirus World

As the ripple of COVID-19 careens around the globe, it’s forcing humankind to innovate and change the way we work and live. The upside of where we find ourselves right now is that individuals and corporations will be more resilient in a post-COVID-19 world. Here are nine predictions of what our world may look like once we have left the pandemic behind.

1.  More Contactless Interfaces and Interactions

There was a time not too long ago when we were impressed by touch screens and all they enabled us to do. COVID-19 has made most of us hyper-aware of every touchable surface that could transmit the disease, so in a post-COVID-19 world, it’s expected that we’ll have fewer touch screens and more voice interfaces and machine vision interfaces. Prior to the pandemic, we saw the rollout of contactless payment options through mobile devices. However, with the increase in people wanting to limit what they touch, an option to pay for goods and services that does not require any physical contact is likely to gain traction. Machine vision interfaces are already used today to apply social media filters and to offer autonomous checkout at some stores. Expect there to be an expansion of voice and machine vision interfaces that recognize faces and gestures throughout several industries to limit the amount of physical contact.

2. Strengthened Digital Infrastructure

COVID-19 caused people to adapt to working from home and in isolation. By forcing our collective hand to find digital solutions to keep meetings, lessons, workouts, and more going when sheltering in our homes, it allowed many of us to see the possibilities for continuing some of these practices in a post-COVID-19 world. For me, I realized that traveling to other countries just for a meeting isn’t always essential, and I have learned that video calls for all kinds of meetings (yes, even board meetings) can be equally effective. My daughter had her first piano lesson over a video call thanks to our social distancing requirements, and it went surprisingly well.

3. Better Monitoring Using IoT and Big Data

We see the power of data in a pandemic in real-time. The lessons we are receiving from this experience will inform how we monitor future pandemics by using internet of things technology and big data. National or global apps could result in better early warning systems because they could report and track who is showing symptoms of an outbreak. GPS data could then be used to track where exposed people have been and who they have interacted with to show contagion. Any of these efforts require careful implementation to safeguard an individual’s privacy and to prevent the abuse of the data but offer huge benefits to more effectively monitor and tackle future pandemics.

4. AI-Enabled Drug Development

The faster we can create and deploy an effective and safe drug to treat and a vaccine to prevent COVID-19 and future viruses, the faster it will be contained. Artificial intelligence is an ideal partner in drug development because it can accelerate and complement human endeavors. Our current reality will inform future efforts to deploy AI in drug development.

 

5. Telemedicine

Have you received the emails from your healthcare professionals that they are open for telemedicine or virtual consultations? To curb traffic at hospitals and other healthcare practitioners’ offices, many are implementing or reminding their patients that consultations can be done through video. Rather than rush to the doctor or healthcare center, remote care enables clinical services without an in-person visit. Some healthcare providers had dabbled in this before COVID-19, but the interest has increased now that social distancing is mandated in many areas.

6. More Online Shopping

Although there were many businesses that felt they had already cracked the online shopping code, COVID-19 taxed the systems like never before as the majority of shopping moved online. Businesses who didn’t have an online option faced financial ruin, and those who had some capabilities tried to ramp up offerings. After COVID-19, businesses that want to remain competitive will figure out ways to have online services even if they maintain a brick-and-mortar location, and there will be enhancements to the logistics and delivery systems to accommodate surges in demand whether that’s from shopper preference or a future pandemic.

7. Increased Reliance on Robots

Robots aren’t susceptible to viruses. Whether they are used to deliver groceries or to take vitals in a healthcare system or to keep a factory running, companies realize how robots could support us today and play an important role in a post-COVID-19 world or during a future pandemic.

8. More Digital Events

Organizers and participants of in-person events that were forced to switch to digital realize there are pros and cons of both. For example, I regularly take part in technology debates in the Houses of Parliament in London. This week’s debate about ‘AI in education’ was done as a virtual event and went very well and actually had more people attend. We didn’t experience a capacity issue as we do with an in-person event, plus there were attendees logged on from all around the world. While I don’t predict that in-person events will be replaced entirely after COVID-19, I do believe event organizers will figure out ways the digital aspects can complement in-person events. I predict a steep rise in hybrid events where parts of the event take place in person, and others are delivered digitally.

9. Rise in Esports

Sporting events, organizations, and fans have had to deal with the reality of their favorite past-times being put on hold or seasons entirely canceled due to COVID-19. But esports are thriving. There are even e-versions of F1 car racing on television, and although it might not be the same as traditional Formula 1 racing, it’s giving people a “sports” outlet. Unlike mainstream sporting events, esporting events can easily transition online. Similarly to events, I predict more hybrid sports coverage where physical events are complemented with digital offerings.

COVID-19 might be taxing our systems and patience, but it’s also building our resilience and allowing us to develop new and innovative solutions out of necessity. In a post-COVID-19 world, I predict we will take the lessons handed to us by our time dealing with the virus and make our world a better place. What do you see in the future?

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For more on AI and technology trends, see Bernard Marr’s book Artificial Intelligence in Practice: How 50 Companies Used AI and Machine Learning To Solve Problems and his forthcoming book Tech Trends in Practice: The 25 Technologies That Are Driving The 4Th Industrial Revolution, which is available to pre-order now.

Follow me on Twitter or LinkedIn. Check out my website.

Bernard Marr is an internationally best-selling author, popular keynote speaker, futurist, and a strategic business & technology advisor to governments and companies. He helps organisations improve their business performance, use data more intelligently, and understand the implications of new technologies such as artificial intelligence, big data, blockchains, and the Internet of Things. Why don’t you connect with Bernard on Twitter (@bernardmarr), LinkedIn (https://uk.linkedin.com/in/bernardmarr) or instagram (bernard.marr)?

Source: 9 Future Predictions For A Post-Coronavirus World

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